Skip to main content
SpringerLink
Log in

„Resuscitative endovascular balloon occlusion of the aorta“

Überbrückende Maßnahme bis zur operativen Versorgung

Resuscitative endovascular balloon occlusion of the aorta

Bridge to surgery

  • Leitthema
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Barnard EBG, Morrison JJ, Madureira RM, Lendrum R, Fragoso-Iniguez M, Edwards A, Lecky F, Bouamra O, Lawrence T, Jansen JO (2015) Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg Med J 32:926–932

    Article  PubMed  PubMed Central  Google Scholar 

  2. Brenner M, Inaba K, Aiolfi A, DuBose J, Fabian T, Bee T, Holcomb JB, Moore L, Skarupa D, Scalea TM, AAST AORTA Study Group (2018) Resuscitative endovascular baloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the American Association for the Surgery of Trauma Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2018.01.044

    Article  PubMed  Google Scholar 

  3. Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, Scalea T (2014) Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg 77:286–291

    Article  PubMed  Google Scholar 

  4. Brenner ML, Moore LJ, DuBose JJ, Tyson GH, McNutt MK, Albarado RP, Holcomb JB, Scalea TM, Rasmussen TE (2013) A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg 75:506–511

    Article  PubMed  Google Scholar 

  5. Coccolini et al (2017) Pelvic trauma WSES classification and guidelines. World J Emerg Surg 12:5

    Article  PubMed  PubMed Central  Google Scholar 

  6. Eastidge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, Butler FK, Kotwal RS, Holcomb JB, Wade C, Champon H, Lawnick M, Moores L, Blackbourne LH (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 73:431–437

    Article  Google Scholar 

  7. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Urike P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE et al (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty car. J Trauma Acute Care Surg 73:S431–S437

    Article  PubMed  Google Scholar 

  8. Edens JW, Beekley AC, Chung KK, Cox ED, Eastridge BJ, Holcomb JB, Blackbourne LH (2009) Longterm outcomes after combat casualty emergency department thoracotomy. J Am Coll Surg 209(2):188–197

    Article  PubMed  Google Scholar 

  9. Guilani S, Amendola M, Strife B, Morano G, Elbich J, Albuquerque F, Komorowski D, Sydnor M, Malhotra A, Levy M (2015) Central aortic wire confirmation for emergent endovascular procedures: as fast as surgeon-performed ultrasound. J Trauma Acute Care Surg 75:549–554

    Article  Google Scholar 

  10. Gupta BK, Khaneja SC, Flores L, Eastlick L, Longmore W, Shaftan GW (1989) The role of intra-aortic balloon occlusion in penetrating abdominal trauma. J Trauma 29(6):861–865

    Article  PubMed  CAS  Google Scholar 

  11. Hughes CW (1954) Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery 36(1):65–68

    PubMed  CAS  Google Scholar 

  12. Johnson MA, Williams TK, Ferencz SE, Davidson AJ, Russo RM, O’Bien WT, Galante JM, Grayson JK, Neff LP (2017) The effect of resuscitative endovascular balloon occlusion of the aorta, partial aortic occlusion and aggressive blood transfusion on traumatic brain injury in a swine multiple injuries model. J Trauma Acute Care Surg 83(1):61–70

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kauvar DS, Lefering R, Wade CE (2006) Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 60(Suppl 6):3–11

    Article  Google Scholar 

  14. Kisat M, Mrrison JJ, Hashmi ZG, Efron DT, Rasmussen TE, Haider AH (2014) Epidermiology and outcomes of non-compressible torso hemorrhage. J Surg Res 184:414–421

    Article  Google Scholar 

  15. Matsumura (2017) It is all about the vascular access. In: Hörer TM (Hrsg) Top stent, 1. Aufl. Örebro University Hospital, Örebro, S 17–42

    Google Scholar 

  16. Mayer D, Pfammatter T, Rancic Z, Hechelhammer L, Wilhelm M, Beith FJ, Lachat M (2009) 10 years of emergency endovascular aneurysm repair for ruptured abdominal aortoiliac aneurysms: lessons learned. Ann Surg 249:510–515

    Article  PubMed  Google Scholar 

  17. Moore LJ, Martin CD, Harvin JA, Wade CE, Holcomb JB (2016) Resuscitative endovascular balloon occlusion of the aorta for control of noncompressible truncal hemorrhage in the abdomen and pelvis. Am J Surg 212(6):1222–1230

    Article  PubMed  Google Scholar 

  18. Morrison JJ, Ross JD, Rasmussen TE, Midwinter MJ, Jansoen JO (2014) Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combad casualties. Shock 41:388–393

    Article  PubMed  Google Scholar 

  19. Morrsion JJ, Galgon RE, Jansen JO, Cannon JW, Rasmussen TE, Eliason JL (2016) A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg 80:324–334

    Article  CAS  Google Scholar 

  20. Norii T, Crandall C, Terasaka Y (2015) Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with prospensity score-adjusted untreated patients. J Trauma Acute Care Surg 78:721–728

    Article  PubMed  Google Scholar 

  21. Okada Y, Narumiyaa H, Ishi W, Liduka R (2017) Anatomical Landmarks for safely implementing resuscitative balloon occlusion of the aorta in zone 1 without fluoroscopy. Scand J Trauma Resusc Emerg Med 25:63

    Article  PubMed  PubMed Central  Google Scholar 

  22. Romagnoli A, Teeter W, Pasley J, Hu P, Hoehn M, Stein D, Scalea T, Brenner M (2016) Time to aortic occlusion: it’s all about access. J Trauma Acute Care Surg 83:1161–1164

    Article  Google Scholar 

  23. Saito N, Matsumoto H, Yagi T, Hara Y, Hayashida K, Motomura T, Mashiko K, Lida H, Yokota H, Wagatsuma Y (2015) Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion oft he aorta. J Trauma Acute Care Surg 78(5):897–903

    Article  PubMed  Google Scholar 

  24. Stannard A, Eliason JL, Rasmussen TE (2011) Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma 71(6):1869–1872

    PubMed  Google Scholar 

  25. Stannard A, Morrison JJ, Scott DJ, Ivatury RA, Ross JD, Rasmussen TE (2013) The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan. J Trauma Acute Care Surg 74(3):830–834

    Article  PubMed  Google Scholar 

  26. White JM, Cannon JW, Stannard A, Markov NP, Spencer JR, Rasmussen TE (2011) Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery 150:400–409

    Article  PubMed  Google Scholar 

  27. White JM, Cannon JW, Stannard A, Spencer JR, Hancock H, Williams K, Oh JS, Rasmussen TE (2011) A porcine model for evaluation the management of noncompressible torso hemorrhage. J Trauma 71:S131–138

    Article  PubMed  Google Scholar 

  28. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons. Committee on trauma (2001) Practice management guidelines for emergency department thoracotomy. J Am Coll Surg 193(3):303–309

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Gefäß- und Thoraxchirurgie, Ammerland-Klinik, Lange Str. 38, 26655, Westerstede, Deutschland

    K. Elias

  2. Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Zentrum für Gefäßmedizin der Bundeswehr, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland

    M. Engelhardt

Authors
  1. K. Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Engelhardt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Elias.

Ethics declarations

Interessenkonflikt

K. Elias und M. Engelhardt geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Engelhardt, Ulm

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-018-0503-x

Schlüsselwörter

Keywords

Search

Navigation