Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

scholarly journals Increased crystalloid fluid requirements during zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) versus Abdominal Aortic and Junctional Tourniquet (AAJT) after class II hemorrhage in swine

2021 ◽  
Author(s):  
Andreas Brännström ◽  
Albin Dahlquist ◽  
Jenny Gustavsson ◽  
Ulf P. Arborelius ◽  
Mattias Günther
Keyword(s):  
Fluid Management ◽  
Class Ii ◽  
Balloon Occlusion ◽  
Metabolic Effects ◽  
Total Blood ◽  
Crystalloid Fluid ◽  
Vasopressor Support ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Abstract Purpose Pelvic and lower junctional hemorrhage result in a significant amount of trauma related deaths in military and rural civilian environments. The Abdominal Aortic and Junctional Tourniquet (AAJT) and infra-renal (zone 3) Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) are two options for resuscitation of patients with life threatening blood loss from and distal to the pelvis. Evidence suggest differences in the hemodynamic response between AAJT and zone 3 REBOA, but fluid management during resuscitation with the devices has not been fully elucidated. We compared crystalloid fluid requirements (Ringer’s acetate) between these devices to maintain a carotid mean arterial pressure (MAP) > 60 mmHg. Methods 60 kg anesthetized and mechanically ventilated male pigs were subjected to a mean 1030 (range 900–1246) mL (25% of estimated total blood volume, class II) haemorrhage. AAJT (n = 6) or zone 3 REBOA (n = 6) were then applied for 240 min. Crystalloid fluids were administered to maintain carotid MAP. The animals were monitored for 30 min after reperfusion. Results Cumulative resuscitative fluid requirements increased 7.2 times (mean difference 2079 mL; 95% CI 627–3530 mL) in zone 3 REBOA (mean 2412; range 800–4871 mL) compared to AAJT (mean 333; range 0–1000 mL) to maintain target carotid MAP. Release of the AAJT required vasopressor support with norepinephrine infusion for a mean 9.6 min (0.1 µg/kg/min), while REBOA release required no vasopressor support. Conclusion Zone 3 REBOA required 7.2 times more crystalloids to maintain the targeted MAP. The AAJT may therefore be considered in a situation of hemorrhagic shock to limit the need for crystalloid infusions, although removal of the AAJT caused more severe hemodynamic and metabolic effects which required vasopressor support.

scholarly journals A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Takahiro Shoji ◽  
Hirohisa Harada ◽  
Shinji Yamazoe ◽  
Yoshihiro Yamaguchi
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Arterial Embolization ◽  
External Iliac Artery ◽  
Vascular Trauma ◽  
Balloon Occlusion ◽  
Arterial Access ◽  
Iatrogenic Complications ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

scholarly journals Vascular Access Training for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Placement: A Feasibility Study in Emergency Physicians

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Suzanne Vrancken ◽  
Rayner Maayen ◽  
Boudewijn Borger van der Burg ◽  
Daniël Eefting ◽  
Thijs Van Dongen ◽  
...  
Keyword(s):  
Training Program ◽  
Vascular Access ◽  
Femoral Artery ◽  
Technical Skills ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Puncture Site ◽  
Anatomical Structures ◽  
And Training ◽  
Endovascular Balloon Occlusion

Background Vascular access is a prerequisite for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) placement. Training such skills to emergency physicians (EPs) could contribute to better outcomes in non-compressible truncal hemorrhage patients. This study aimed to determine whether a concise training program could train EPs to recognize anatomical structures and correctly visualize and identify the puncture site for percutaneous placement of a REBOA catheter. Methods Eleven EPs participated in our training program, including basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills to include: identification of anatomical structures, anatomical knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the Common Femoral Artery (CFA) with ultrasound. Consultant vascular surgeons functioned as expert controls. Results EPs had a median overall technical skills score of 32.5 [27.0-35.0]. All EPs were able to identify the correct CFA puncture site with a median time of 52.9 seconds [35.6-63.7] at the first attempt and 34.0 seconds [21.2-44.7] at the post-test (Z=-2.756, p=0.006). Consultant vascular surgeons were significantly faster (p=0.000). Conclusions EPs are capable of visualizing the femoral artery and vein within one minute. The speed of correct visualisation improved rapidly after repetition. Our concise theoretical and practical training program proved useful regardless of prior endovascular experience and training. This program, as a component of an expanded Endovascular Resuscitation and Trauma Management curriculum, in combination with realistic task training models (simulator, perfused cadaver, or live tissue) has the potential to provide effective training of the skills required to competently perform REBOA.

scholarly journals Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians

2019 ◽  
Vol 4 (1) ◽  
pp. e000376 ◽  
Author(s):  
Eileen M Bulger ◽  
Debra G Perina ◽  
Zaffer Qasim ◽  
Brian Beldowicz ◽  
Megan Brenner ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
National Association ◽  
Emergency Medical Technicians ◽  
Emergency Physicians ◽  
Trauma Systems ◽  
Emergency Medical ◽  
Civilian Trauma ◽  
American College Of Surgeons ◽  
The Usa ◽  
Endovascular Balloon Occlusion

This is a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians regarding the clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA. This statement addresses the system of care needed to manage trauma patients requiring the use of REBOA, in light of the current evidence available in this patient population. This statement was developed by an expert panel following a comprehensive review of the literature with representation from all sponsoring organizations and the US Military. This is an update to the previous statement published in 2018. It has been formally endorsed by the four sponsoring organizations.

scholarly journals Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0174520 ◽  
Author(s):  
Knut Haakon Stensaeth ◽  
Edmund Sovik ◽  
Ingrid Natasha Ylva Haig ◽  
Erna Skomedal ◽  
Arve Jorgensen
Keyword(s):  
Postpartum Hemorrhage ◽  
Balloon Occlusion ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Resuscitative endovascular balloon occlusion of the aorta for pelvic blunt trauma and life-threatening hemorrhage

2018 ◽  
Vol 84 (3) ◽  
pp. 449-453 ◽  
Author(s):  
Audrey Pieper ◽  
Frédéric Thony ◽  
Julien Brun ◽  
Mathieu Rodière ◽  
Bastien Boussat ◽  
...  
Keyword(s):  
Blunt Trauma ◽  
Balloon Occlusion ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion
Sign in / Sign up

Export Citation Format

Share Document