Zusammenfassung
Hintergrund
Unbeherrschbare Blutungen sind nach wie vor die häufigste Todesursache bei Unfallopfern. Die „resuscitative balloon occlusion of the aorta“ (REBOA) stellt eine endovaskuläre Alternative zur etablierten Notfallthorakotomie mit aortalem „cross-clamping“ bei Patienten mit schwerer abdomineller oder pelviner Blutung dar.
Ziel der Arbeit
Der Beitrag vermittelt erste Erfahrungen mit REBOA.
Methode
Anhand der aktuellen Literatur und eigener Erfahrungen werden die pathophysiologischen Hintergründe, Indikationen, Kontraindikationen, technische Details und erste Ergebnisse mit REBOA dargestellt.
Ergebnisse
Das Verfahren ist indiziert bei Patienten im therapierefraktären hämorrhagischen Schock mit abdomineller oder pelviner Blutung. Über einen transfemoralen Zugang wird ein Okklusionsballon in der Aorta platziert und gefüllt. Je nach Indikation erfolgt die aortale Okklusion supradiaphragmal (Zone I) oder infrarenal (Zone III). Experimentelle Ergebnisse belegen einen signifikanten Anstieg des zentralen Perfusionsdrucks durch das Manöver. Erste klinische Daten deuten darüber hinaus eine Verbesserung der Überlebensrate von Traumapatienten an. Mit Weiterentwicklung der Katheter und Minimierung des Zugangstraumas durch Einführung von kleinlumigen 7‑F-Schleusen konnte die perioperative Komplikationsrate gesenkt werden.
Schlussfolgerung
„Resuscitative endovascular balloon occlusion of the aorta“ ist ein vielversprechendes endovaskuläres Verfahren zur temporären Kreislaufstabilisierung von Patienten im hämorrhagischen Schock. Die klinische Überlegenheit der Technik gegenüber der klassischen Notfallthorakotomie muss jedoch erst in größeren Registerstudien belegt werden.
Abstract
Background
Severe hemorrhage remains the leading cause of death among trauma patients. Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular alternative to the established emergency room thoracotomy with cross-clamping of the aorta in patients with severe abdominal or pelvic bleeding.
Objective
The article reports on initial experiences with REBOA.
Methods
Based on the literature and own experiences the pathophysiology, indications, contraindications, technical details and first results with REBOA are presented.
Results
The REBOA procedure is indicated in patients with treatment-refractive hemorrhagic shock with severe abdominal or pelvic bleeding. Via a transfemoral approach a balloon catheter is placed in the aorta and inflated. Depending on the indication the aortic occlusion is located in a supradiaphragmatic (zone 1) or infrarenal (zone 3) position. Experimental results proved a significant increase in central perfusion pressure after performance of REBOA. Furthermore, first clinical data indicate an improved patient survival rate after trauma. Improvements of the devices and minimizing the access trauma using small 7 Fr sheaths decreased the perioperative complication rate.
Conclusion
The REBOA procedure is a promising endovascular technique for temporary stabilization of the circulation in patients with hemorrhagic shock. Further clinical studies and registries have yet to prove its superiority over emergency room thoracotomy.
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K. Elias und M. Engelhardt geben an, dass kein Interessenkonflikt besteht.
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Elias, K., Engelhardt, M. „Resuscitative endovascular balloon occlusion of the aorta“. Unfallchirurg 121, 537–543 (2018). https://doi.org/10.1007/s00113-018-0503-x
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DOI: https://doi.org/10.1007/s00113-018-0503-x