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    Contemporary utilization of zone III REBOA for temporary control of pelvic and lower junctional hemorrhage reliably achieves hemodynamic stability in severely injured patients

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    Author
    Pasley, Jason D.
    Brenner, Megan
    Pasley, Amelia
    Moore, Laura J.
    Scalea, Thomas M.
    Dubose, Joseph
    Date
    2019-04-25
    Journal
    Journal of Endovascular Resuscitation and Trauma Management
    Publisher
    Orebro University Hospital
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.26676/jevtm.v3i2.89
    Abstract
    Background: Aortic occlusion is a valuable adjunct for the management of traumatic pelvic and lower extremity junctional hemorrhage. Methods: The American Association for the Surgery of Trauma Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery registry was reviewed for patients requiring Zone III resuscitative endovascular balloon occlusion of the aorta (REBOA) from eight verified trauma centers. After excluding patients in arrest, demographics, elements of treatment, and outcomes were identified. Results: From November 2013 to December 2016, 30 patients had Zone III REBOA placed. Median age was 41.0 (interquartile range, IQR, 38); median injury severity score was 41.0 (IQR 12). Hypotension (SBP < 90 mm Hg) was present on admission in 30.0% and tachycardia (HR > 100 bpm) in 66.7%. Before REBOA placement, vital signs changed in this cohort with hypotension in 83.3% and tachycardia noted in 90%. Median initial pH was 7.14 (IQR 0.22), and median admission lactate 9.9 mg/dL (IQR 5). Pelvic binders were utilized in 40%. Occlusion balloon devices included Coda™ (70%), ER REBOA™ (13.3%), Reliant™ (10%). After REBOA, hemodynamics improved in 96.7% and stability (BP consistently > 90 mm Hg) was achieved in 86.7%. Median duration of REBOA was 53.0 mins (IQR 112). Median PRBC and FFP requirements were 19.0 units (IQR (17) and 17.0 units (IQR 14), respectively. One amputation unrelated to REBOA utilization was required. Systemic complications included AKI (23.3%) and MODS (10%). REBOA specific complications included groin hematoma (3.3%) and distal thromboembolization (16.7%). Survival to discharge was 56.7%, with in-hospital deaths occurring in the ED 7.7%, OR 23.1%, ICU 69.2%. Conclusions: This review discusses the specifics of the contemporary use of Zone III REBOA placement as well as local and systemic complications for patients in extremis with pelvic/junctional hemorrhage. Further review is required to determine optimal patient selection.
    Keyword
    Junctional Hemorrhage
    Pelvic Bleeding
    Zone III REBOA
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/14007
    ae974a485f413a2113503eed53cd6c53
    10.26676/jevtm.v3i2.89
    Scopus Count
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    UMB Open Access Articles 2020

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