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Resuscitative Endovascular Balloon Occlusion of the Aorta

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Textbook of Polytrauma Management

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Abstract

Resuscitative endovascular balloon occlusion of the aorta is an endovascular technique for the resuscitation of patients with exsanguinating subdiaphragmatic hemorrhage. It provides an alternative to emergency department thoracotomy (EDT) and aortic clamping. Animal data suggests that REBOA provides physiological and survival advantage over standard treatments yet full adoption has been gradual and hotly debated. Femoral arterial cannulation is a crucial step and should be done with ultrasound imaging or by “cutting-down” on patients in extremis. Balloon occlusion time is carefully monitored and kept to <30 min when placed in Zone I (thoracic aorta)—as prolonged occlusion (>30 min) may have adverse consequences. Longer occlusion periods (<2 h) are usually tolerable in Zone III (above the aortic bifurcation). General indications, a proposed algorithm, and potential complications are the purpose of this report. Future directions for REBOA include the development of a novel partial occlusion catheter and extending the current applications for the non-trauma patient.

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Author information

Authors and Affiliations

  1. Division of Vascular Surgery, Department of Surgery, The R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA

    Charles J. Fox

  2. Shock Trauma Center, Denver Health Medical Center, Denver, CO, USA

    Ernest E. Moore

  3. Department of Surgery, Division of GI, Trauma, and Endocrine Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Ernest E. Moore

Authors
  1. Charles J. Fox
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Correspondence to Charles J. Fox .

Editor information

Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

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Fox, C.J., Moore, E.E. (2022). Resuscitative Endovascular Balloon Occlusion of the Aorta. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_8

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  • DOI: https://doi.org/10.1007/978-3-030-95906-7_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

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