Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects
Abstract Background The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment. In addition, because no specific REBOA...
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doaj-42165d30213548a29a67daac5b004a5e2020-11-25T01:57:56ZengBMCWorld Journal of Emergency Surgery1749-79222018-11-0113111110.1186/s13017-018-0213-2Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspectsJ. C. de Schoutheete0I. Fourneau1F. Waroquier2L. De Cupere3M. O’Connor4K. Van Cleynenbreugel5J. C. Ceccaldi6S. Nijs7Burn Unit, Queen Astrid Military HospitalDepartment of Vascular Surgery, University Hospitals LeuvenBurn Unit, Queen Astrid Military HospitalBurn Unit, Queen Astrid Military Hospital175th Surgical Detachment, US Army, Fort CampbellBurn Unit, Queen Astrid Military HospitalBurn Unit, Queen Astrid Military HospitalDepartment of Trauma Surgery, University Hospitals LeuvenAbstract Background The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment. In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm. Methods Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2). Results Systolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2. Conclusions ER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion.http://link.springer.com/article/10.1186/s13017-018-0213-2Resuscitative endovascular balloon occlusion of the aortaREBOAPartial REBOAShockTraumaPre-hospital |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
J. C. de Schoutheete I. Fourneau F. Waroquier L. De Cupere M. O’Connor K. Van Cleynenbreugel J. C. Ceccaldi S. Nijs |
spellingShingle |
J. C. de Schoutheete I. Fourneau F. Waroquier L. De Cupere M. O’Connor K. Van Cleynenbreugel J. C. Ceccaldi S. Nijs Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects World Journal of Emergency Surgery Resuscitative endovascular balloon occlusion of the aorta REBOA Partial REBOA Shock Trauma Pre-hospital |
author_facet |
J. C. de Schoutheete I. Fourneau F. Waroquier L. De Cupere M. O’Connor K. Van Cleynenbreugel J. C. Ceccaldi S. Nijs |
author_sort |
J. C. de Schoutheete |
title |
Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects |
title_short |
Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects |
title_full |
Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects |
title_fullStr |
Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects |
title_full_unstemmed |
Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment—technical and methodological aspects |
title_sort |
three cases of resuscitative endovascular balloon occlusion of the aorta (reboa) in austere pre-hospital environment—technical and methodological aspects |
publisher |
BMC |
series |
World Journal of Emergency Surgery |
issn |
1749-7922 |
publishDate |
2018-11-01 |
description |
Abstract Background The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment. In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm. Methods Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2). Results Systolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2. Conclusions ER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion. |
topic |
Resuscitative endovascular balloon occlusion of the aorta REBOA Partial REBOA Shock Trauma Pre-hospital |
url |
http://link.springer.com/article/10.1186/s13017-018-0213-2 |
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