Page 48 - JSOM Spring 2018

Abstracts of Articles on REBOA
Published in JSOM in 2017

A MODERN CASE SERIES OF RESUSCITATIVE ABSTRACT
ENDOVASCULAR BALLOON OCCLUSION OF Background: Resuscitative endovascular balloon occlusion of
THE AORTA (REBOA) IN AN OUT-OF-HOSPITAL, the aorta (REBOA), used to temporize noncompressible and
COMBAT CASUALTY CARE SETTING
junctional hemorrhage, may be deployable to the forward en-
Manley JD, Mitchell BJ, DuBose JJ, Rasmussen TE. 17(1). vironment. Our hypothesis was that nonsurgeon physicians
1–8. (Case Reports) and high-level military medical technicians would be able to
learn the theory and insertion of REBOA. Methods: US Army
ABSTRACT Special Operations Command medical personnel without
prior endovascular experience were included. All participants
Background: Resuscitative endovascular balloon occlusion of received didactic instruction of the Basic Endovascular Skills
the aorta (REBOA) is used to mitigate bleeding and sustain for Trauma Course together, with individual evaluation of
™
central aortic pressure in the setting of shock. The ER-REBOA technical skills. A pretest and a posttest were administered
™
catheter is a new REBOA technology, previously reported only to assess comprehension. Results: Four members of US Army
in the setting of civilian trauma and injury care. The use of Special Operations Command—two nonsurgeon physicians,
REBOA in an out-of-hospital setting has not been reported, to one physician assistant, and one Special Operations Combat
our knowledge. Methods: We present a case series of wartime Medic—were included. REBOA procedural times moving
injured patients cared for by a US Air Force Special Operations from trial 1 to trial 6 decreased significantly from 186 ± 18.7
Surgical Team at an austere location fewer than 3km (5-10 seconds to 83 ± 10.3 seconds (ρ < .0001). All participants
minutes’ transport) from point of injury and 2 hours from the demonstrated safe REBOA insertion and verbalized the indica-
next highest environment of care-a Role 2 equivalent. Results: tions for REBOA insertion and removal through all trials. All
In a 2-month period, four patients presented with torso gun- five procedural tasks were performed correctly by each par-
shot or fragmentation wounds, hemoperitoneum, and class IV ticipant. Comprehension and knowledge between the pretest
shock. Hand-held ultrasound was used to diagnose hemoperi- and posttest improved significantly from 67.6 ± 7.3% to 81.3
toneum and facilitate 7Fr femoral sheath access. ER- REBOA ± 8.1% (ρ = .039). Conclusion: This study demonstrates that
balloons were positioned and inflated in the aorta (zone 1 nonsurgeon and nonphysician providers can learn the steps
[n = 3] and zone 3 [n = 1]) without radiography. In all cases, required for REBOA after arterial access is established. Al-
REBOA resulted in immediate normalization of blood pressure though insertion is relatively straightforward, the inability to
and allowed induction of anesthesia, initiation of whole-blood gain arterial access percutaneously is prohibitive in providers
transfusion, damage control laparotomy, and attainment of without a surgical skillset and should be the focus of further
surgical hemostasis (range of inflation time, 18-65 minutes). training.
There were no access- or REBOA-related complications and
all patients survived to achieve transport to the next echelon
of care in stable condition. Conclusion: To our knowledge, this Keywords: REBOA; resuscitative endovascular balloon oc-
is the first series to demonstrate the feasibility and effective- clusion of the aorta; training; virtual reality simulation; junc-
ness of REBOA in modern combat casualty care and the first tional hemorrhage; noncompressable torso hemorrhage
to describe use of the ER-REBOA catheter. Use of this device
by nonsurgeons and surgeons not specially trained in vascular
surgery in the out-of-hospital setting is useful as a stabilizing A PERSPECTIVE ON THE POTENTIAL FOR
and damage control adjunct, allowing time for resuscitation, BATTLEFIELD RESUSCITATIVE ENDOVASCULAR
laparotomy, and surgical hemostasis. BALLOON OCCLUSION OF THE AORTA

Keywords: REBOA; endovascular balloon occlusion; shock, Knight RM. 17(1). 72–75. (Journal Article)
hemorrhagic; austere environments
ABSTRACT
Resuscitative endovascular balloon occlusion of the aorta
(REBOA) has a place in civilian trauma centers in the United
RESUSCITATIVE ENDOVASCULAR BALLOON States, and British physicians performed the first prehospital
OCCLUSION OF THE AORTA: PUSHING CARE REBOA, proving the concept viable for civilian emergency
FORWARD
medical service. Can this translate into battlefield REBOA to
Teeter WA, Romagnoli A, Glaser J, Fisher AD, stop junctional hemorrhage and extend “golden hour” rings in
Pasley J, Scheele B, Hoehn M, Brenner ML. 17(1). 17–21. combat? If yes, at what level is this procedure best suited and
(Case Reports) what does it entail? This author’s perspective, after treating

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