Top

BMC Surgery

Published in:

Open Access 01-12-2022 | Research

A clinical study of the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections

Authors: Zhiqing Zhao, Jichuan Wang, Taiqiang Yan, Wei Guo, Rongli Yang, Xiaodong Tang, Yi Yang

Published in: BMC Surgery | Issue 1/2022

Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key procedure in sacral and pelvic tumor resection that provides hemorrhage control. However, few studies have been performed to capture the effects of REBOA in a nonshock condition and provide a detailed description of the changes occurring with prolonged occlusion time. This study aimed to examine the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections following different periods of REBOA.

Methods

In total, 121 patients who underwent surgical tumor resections of the pelvis and/or the sacrum with the use of aortic balloon occlusion were prospectively enrolled from October 2020 to December 2021. All cases were divided into Group A (occlusion time ≤ 60 min, n = 57) and Group B (occlusion time ≥ 90 min, n = 64). Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals.

Results

Balloon inflation resulted in a significant increase in SBP from 106 to 120 mmHg and decreased to 96 mmHg immediately following balloon deflation. With the application of REBOA, the median blood loss was only 1200 ml (range, 400–7900). When deflating the REBOA, the arterial pH was lower than baseline (7.36 vs. 7.41, p < 0.01), the arterial lactate concentration increased from 0.9 to 1.4 mmol/L (p < 0.01), serum potassium measurements increased from 3.99 to 4.12 mmol/L, serum calcium measurements decreased from 2.31 to 2.04 mmol/L, and blood creatinine decreased from 64 to 60 µmol/L. The operating time of Group B was longer than that of patients in Group A, and the patients in Group B needed more blood units to be transfused. Although laboratory measurements, including pH, potassium, calcium, and blood creatinine, were at the same level in two groups comparison, the lactate was significantly higher in Group B after deflation (p = 0.01).

Conclusions

The results of this study showed that acceptable hemodynamic and metabolic stability can be attained when the occlusion time of REBOA is more than 90 min, although the long duration of occlusion caused relatively higher lactate levels.

Luo Y, Duan H, Liu W, Min L, Shi R, Zhang W, Zhou Y, Tu C. Clinical evaluation for lower abdominal aorta balloon occluding in the pelvic and sacral tumor resection. J Surg Oncol. 2013;108:148–51. https://doi.org/10.1002/jso.23376.CrossRefPubMed

Mi C, Lu H, Liu H. Surgical excision of sacral tumors assisted by occluding the abdominal aorta with a balloon dilation catheter: a report of 3 cases. Spine. 2005;30:E614-616. https://doi.org/10.1097/01.brs.0000182111.64825.CrossRefPubMed

Ratto N, Boffano M, Pellegrino P, Conti A, Rossi L, Verna V, Rastellino V, Berardino M, Piana R. The intraoperative use of aortic balloon occlusion technique for sacral and pelvic tumor resections: a case-control study. Surg Oncol. 2020;32:69–74. https://doi.org/10.1016/j.suronc.2019.11.003.CrossRefPubMed

Tang X, Guo W, Yang R, Tang S, Dong S. Use of aortic balloon occlusion to decrease blood loss during sacral tumor resection. J Bone Joint Surg Am. 2010;92:1747–53. https://doi.org/10.2106/JBJS.I.01333.CrossRefPubMed

Yang L, Chong-Qi T, Hai-Bo S, Lan Z, Tian-Fu Y, Hong D, Fu-Xing P. Appling the abdominal aortic-balloon occluding combine with blood pressure sensor of dorsal artery of foot to control bleeding during the pelvic and sacrum tumors surgery. J Surg Oncol. 2008;97:626–8. https://doi.org/10.1002/jso.21026.CrossRefPubMed

Zhang L, Gong Q, Xiao H, Tu C, Liu J. Control of blood loss during sacral surgery by aortic balloon occlusion. Anesth Analg. 2007;105:700–3. https://doi.org/10.1213/01.ane.0000278135.85206.4e.CrossRefPubMed

Zhang Y, Guo W, Tang X, Yang R, Yan T, Dong S, Wang S, Zaphiros N. Can aortic balloon occlusion reduce blood loss during resection of sacral tumors that extend into the lower lumber spine? Clin Orthop Relat Res. 2018;476:490–8. https://doi.org/10.1007/s11999.0000000000000053.CrossRefPubMedPubMedCentral

Markov NP, Percival TJ, Morrison JJ, Ross JD, Scott DJ, Spencer JR, Rasmussen TE. Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Surgery. 2013;153:848–56. https://doi.org/10.1016/j.surg.2012.12.001.CrossRefPubMed

Morrison JJ, Ross JD, Markov NP, Scott DJ, Spencer JR, Rasmussen TE. The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock. J Surg Res. 2014;191:423–31. https://doi.org/10.1016/j.jss.2014.04.012.CrossRefPubMed

10.

Scott DJ, Eliason JL, Villamaria C, Morrison JJ, Rt H, Spencer JR, Rasmussen TE. A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock. J Trauma Acute Care Surg. 2013;75:122–8. https://doi.org/10.1097/ta.0b013e3182946746.CrossRefPubMed

11.

Reva VA, Matsumura Y, Hörer T, Sveklov DA, Denisov AV, Telickiy SY, Seleznev AB, Bozhedomova ER, Matsumoto J, Samokhvalov IM, Morrison JJ. Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock? Eur J Trauma Emerg Surg. 2018;44:511–8. https://doi.org/10.1007/s00068-016-0732-z.CrossRefPubMed

12.

Yamashiro KJ, Galganski LA, Grayson JK, Johnson MA, Beyer CA, Spruce MW, Caples CM, Trappey AF, Wishy AM, Stephenson JT. Resuscitative endovascular balloon occlusion of the aorta in a pediatric swine model: Is 60 minutes too long? J Trauma Acute Care Surg. 2020;89:616–22. https://doi.org/10.1097/ta.0000000000002620.CrossRefPubMed

13.

Madurska MJ, Jansen JO, Reva VA, Mirghani M, Morrison JJ. The compatibility of computed tomography scanning and partial REBOA: a large animal pilot study. J Trauma Acute Care Surg. 2017;83:557–61. https://doi.org/10.1097/ta.0000000000001574.CrossRefPubMed

14.

Sadeghi M, Dogan EM, Karlsson C, Jansson K, Seilitz J, Skoog P, Hörer TM, Nilsson KF. Total resuscitative endovascular balloon occlusion of the aorta causes inflammatory activation and organ damage within 30 minutes of occlusion in normovolemic pigs. BMC Surg. 2020;20:43. https://doi.org/10.1186/s12893-020-00700-3.CrossRefPubMedPubMedCentral

15.

Eliason JL, Myers DD, Ghosh A, Morrison JJ, Mathues AR, Durham L, Dunivant V, Gonzalez AA, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA): Zone I balloon occlusion time affects spinal cord injury in the nonhuman primate model. Ann Surg. 2021;274:e54–61. https://doi.org/10.1097/sla.0000000000003408.CrossRefPubMed

16.

Wikström MB, Smårs M, Karlsson C, Stene Hurtsén A, Hörer TM, Nilsson KF. A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock. J Trauma Acute Care Surg. 2021;90:817–26. https://doi.org/10.1097/ta.0000000000003098.CrossRefPubMedPubMedCentral

Title: A clinical study of the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections
Authors: Zhiqing Zhao
Jichuan Wang
Taiqiang Yan
Wei Guo
Rongli Yang
Xiaodong Tang
Yi Yang
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-022-01694-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A clinical study of the hemodynamic and metabolic effects of Zone 3 REBOA for sacral and pelvic tumor resections

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Recurrent bleeding after rubber band ligation diagnosed as mild hemophilia B: a case report and literature review

Reverse rolling-mat type lymph node dissection is the key step to solve the operative difficulties in hand-assisted laparoscopic D2 radical gastrectomy

Ileal ureteral replacement for the management of ureteral avulsion during ureteroscopic lithotripsy: a case series

Application of hepatic lobe hyperplasia techniques in the treatment of advanced hepatic alveolar echinococcosis: a single-centre experience

Management and long-term outcomes of acute right colonic diverticulitis and risk factors of recurrence

Long-term outcomes of transanal endoscopic microsurgery for the treatment of rectal neuroendocrine tumors