Page 29 - Journal of Special Operations Medicine - Spring 2017

setting and describes the utility of the ER-REBOA de- 6. Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review
vice. This experience highlights several key elements of the use of resuscitative endovascular balloon occlusion of
of value in the conduct of REBOA in this setting, in- the aorta in the management of hemorrhagic shock. J Trauma
Acute Care Surg. 2016;80:324–334.
cluding the use of a handheld ultrasound device as a 7. Morrison JJ, Ross JD, Houston R 4th, et al. Use of resuscita-
multifaceted adjunct. This report demonstrates that tive endovascular balloon occlusion of the aorta in a highly
safe and effective positioning and inflation of the ER- lethal model of noncompressible torso hemorrhage. Shock.
REBOA catheter can be accomplished without the use 2014;41:130–137.
of radiography and confirms the effectiveness of this 8. Hughes CW. Use of an intra-aortic balloon catheter tampon-
ade for controlling intraabdominal hemorrhage in man. Sur-
device in stabilizing patients until resuscitation can be- gery. 1954;36:65–68.
gin and surgical hemostasis can be obtained. Finally, 9. Starnes BW, Quiroga E, Hutter C, et al. Management of rup-
observations from this experience show that REBOA is tured abdominal aortic aneurysm in the endovascular era. J
a viable resuscitative capability for the austere, out-of- Vasc Surg. 2010;51:9–17.
hospital setting when used by an appropriately trained 10. Arthurs ZM, Starnes BW, Sohn VY. Ruptured abdominal
aortic aneurysms: remote aortic occlusion for the general sur-
team. geon. Surg Clin North Am. 2007;87:1035–1045.
11. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battle-
field (2001-2011): implications for the future of combat casu-
Acknowledgments alty care. J Trauma Acute Care Surg. 2012;73:S431–S437.
We thank Lt Col Matthew R. Uber, USAF, MSN, CRNA, 12. Morrison JJ, Rasmussen TE. Noncompressible torso hemor-
NC, Department of Anesthesia, University of Alabama rhage: a review with contemporary definitions and manage-
ment strategies. Surg Clin North Am. 2012;92:843–858, vii.
Medical Center; TSgt Richard R. Holguin, USAF, AAS, 13. Stannard A, Morrison JJ, Scott DJ, et al. The epidemiology
CRT, respiratory therapist, Department of Respiratory of noncompressible torso hemorrhage in the wars in Iraq and
Care Services, University of Alabama Medical Center; Afghanistan. J Trauma Acute Care Surg. 2013;74:830–834.
Maj Nelson Pacheco, USAF, BSN, NC, CCRN; and 14. Stannard A, Eliason JL, Rasmussen TE. Resuscitative endo-
Capt Cade A. Reedy, USAF, BSN, NC, CCRN, Univer- vascular balloon occlusion of the aorta (REBOA) as an ad-
junct for hemorrhagic shock. J Trauma. 2011;71:1869–1872.
sity of Alabama Medical Center. 15. Scott DJ, Eliason JL, Villamaria C, et al. A novel fluoroscopy-
free, resuscitative endovascular aortic balloon occlusion sys-
tem in a model of hemorrhagic shock. J Trauma Acute Care
Disclaimer Surg. 2013;75:122–128.

The viewpoints expressed in this manuscript are those 16. Keller BA, Salcedo ES, Williams TK, et al. Design of a cost
effective, hemodynamically adjustable model for resuscitative
of the authors and do not represent official positions of endovascular balloon occlusion of the aorta (REBOA) simu-
the US Air Force or Department of Defense. lation. J Trauma Acute Care Surg. 2016;81:606–611.
17. Russo R, Neff LP, Johnson MA, et al. Emerging endovascu-
lar therapies for non-compressible torso hemorrhage. Shock.
Disclosures 2016;46(3 suppl 1):1–28.
18. Pryor Medical Devices. Pryor Medical Devices receives 510(k)
The authors have nothing to disclose. clearance for distribution of ER-REBOA catheter. http://www
.meddeviceonline.com/doc/pryor-medical-devices-receives-k
References -clearance-for-distribution-of-er-reboa-catheter-0001. Accessed
14 August 2016.
1. Moore LJ, Brenner M, Kozar RA, et al. Implementation of re- 19. Norii T, Crandall C, Terasaka Y. Survival of severe blunt
suscitative endovascular balloon occlusion of the aorta as an trauma patients treated with resuscitative endovascular bal-
alternative to resuscitative thoracotomy for noncompressible loon occlusion of the aorta compared with propensity score-
truncal hemorrhage. J Trauma Acute Care Surg. 2015;79(4): adjusted untreated patients. J Trauma Acute Care Surg. 2015;
523–532. 78:721–728.
2. Brenner M, Moore L, Dubose J, et al. A clinical series of re- 20. Rasmussen T, Baer D, Doll B, et al. In the ‘golden hour’:
suscitative endovascular balloon occlusion of the aorta for combat casualty care research drives innovation to improve
hemorrhage control and resuscitation. J Trauma. 2013;75: survivability and reimagine future combat care. Army AL&T
506–511. Magazine. 2015;Jan–Mar:80–85.
3. Martinelli T, Thony F, Decléty P, et al. Intra-aortic balloon oc- 21. Villamaria CY, Eliason JL, Napolitano LM, et al. Endovas-
clusion to salvage patients with life threatening hemorrhagic cular Skills for Trauma and Resuscitative Surgery (ESTARS)
shocks from pelvic fractures. J Trauma. 2010;68:942–948. course: curriculum development, content validation and pro-
4. DuBose JJ, Scalea TM, Brenner M, et al; AAST AORTA Study gram assessment. J Trauma Acute Care Surg. 2014;76:929–
Group.The AAST Prospective Aortic Occlusion for Resuscita- 935; discussion 935–936.
tion in Trauma and Acute Care Surgery (AORTA) Registry: 22. Brenner M, Hoehn M, Pasley J, et al. Basic endovascular
data on contemporary utilization and outcomes of aortic occlu- skills for trauma course: bridging the gap between endovas-
sion and resuscitative balloon occlusion of the aorta ( REBOA). cular techniques and the acute care surgeon. J Trauma Acute
J Trauma Acute Care Surg. 2016;81:409–419. Care Surg. 2014;77:286–291.
5. White JM, Cannon JW, Stannard A, et al. Endovascular bal- 23. Brenner M, Hoehn M, Stein DM, et al. Central pressurized
loon occlusion of the aorta is superior to resuscitative thoracot- cadaver model (CPCM) for resuscitative endovascular bal-
omy with aortic clamping in a porcine model of hemorrhagic loon occlusion of the aorta (REBOA) training and device test-
shock. Surgery. 2011;150:400–409. ing. J Trauma Acute Care Surg. 2015;78:197–200.

REBOA in CCC Setting 7