Top

European Journal of Trauma and Emergency Surgery

Published in:

01-02-2021 | Review Article

A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

Authors: Suzanne M. Vrancken, Boudewijn L. S. Borger van der Burg, Paul J. E. M. Vrancken, Gert-Aldert H. Kock, Todd E. Rasmussen, Rigo Hoencamp

Published in: European Journal of Trauma and Emergency Surgery | Issue 1/2021

Abstract

Purpose

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation.

Methods

We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device.

Results

Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda^®-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty^®-45 and LeMaitre^®-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda^®-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon^®. ER-REBOA™, Fogarty^®, LeMaitre^®, REBOA Balloon^®, and Rescue Balloon™ are provided with external length marks to assist blind positioning.

Conclusion

In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty^®, and LeMaitre^®, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50^® has several features that facilitate use and reduce the risk of malplacement or vessel damage.

Available only for authorised users

Brenner M, Bulger EM, Perina DG, Henry S, Kang CS, Rotondo MF, et al. Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Trauma Surg Acute Care Open. 2018;3(1):e000154. https://doi.org/10.1136/tsaco-2017-000154.CrossRefPubMedPubMedCentral

Davidson AJ, Russo RM, Reva VA, Brenner ML, Moore LJ, Ball C, et al. The pitfalls of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2018;84(1):192–202. https://doi.org/10.1097/ta.0000000000001711.CrossRefPubMed

Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011;71(6):1869–72. https://doi.org/10.1097/TA.0b013e31823fe90c.CrossRefPubMed

Dunn EL, Moore EE, Moore JB. Hemodynamic effectsof aortic occlusion during hemorrhagic shock. Ann Emerg Med. 1982;11(5):238–41. https://doi.org/10.1016/s0196-0644(82)80090-5.CrossRefPubMed

Markov NP, Percival TJ, Morrison JJ, Ross JD, Scott DJ, Spencer JR, et al. Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock. Surgery. 2013;153(6):848–56. https://doi.org/10.1016/j.surg.2012.12.001.CrossRefPubMed

White JM, Cannon JW, Stannard A, Markov NP, Spencer JR, Rasmussen TE. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery. 2011;150(3):400–9. https://doi.org/10.1016/j.surg.2011.06.010.CrossRefPubMed

Rasmussen TE, Franklin CJ, Eliason JL. Resuscitative Endovascular Balloon Occlusion of the Aorta for hemorrhagic shock. JAMA Surgery. 2017;152(11):1072–3. https://doi.org/10.1001/jamasurg.2017.3428.CrossRefPubMed

Ribeiro Junior MAF, Feng CYD, Nguyen ATM, Rodrigues VC, Bechara GEK, De-Moura RR, et al. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World J Emerg Surg. 2018. https://doi.org/10.1186/s13017-018-0181-6.CrossRefPubMedPubMedCentral

Onishi Y, Kimura H, Kanagaki M, Oka S, Fukumoto G, Otani T, et al. Loop formation by an aortic occlusion balloon catheter during resuscitative endovascular balloon occlusion of the aorta (REBOA). Radiol Case Rep. 2019;14(2):184–6. https://doi.org/10.1016/j.radcr.2018.10.018.CrossRefPubMed

10.

Borger van der Burg BLS, Van Schaik J, Brouwers JJWM, Wong CY, Rasmussen TE, Hamming JF, et al. Migration of aortic occlusion balloons in an in vitro model of the human circulation. Injury. 2019;50(2):286–91. https://doi.org/10.1016/j.injury.2018.12.026.CrossRefPubMed

11.

Hörer TM, Cajander P, Jans A, Nilsson KF. A case of partial aortic balloon occlusion in an unstable multi-trauma patient. Trauma. 2016;18(2):150–4. https://doi.org/10.1177/1460408615624727.CrossRef

12.

van der Wal H, van Dongen TTCF, Vermeulen CFW, Bruce JL, Bekker W, Manchev V, et al. Developing a blueprint for a civilian-military collaborative program in trauma training for northern European countries: a South African experience. Injury. 2020;51(1):70–5. https://doi.org/10.1016/j.injury.2019.07.034.CrossRefPubMed

13.

Buck DB, Karthaus EG, Soden PA, Ultee KH, van Herwaarden JA, Moll FL, et al. Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg. 2015;62(1):16–211. https://doi.org/10.1016/j.jvs.2015.01.058.CrossRefPubMedPubMedCentral

14.

Nakamura M, Chakravarty T, Jilaihawi H, Doctor N, Dohad S, Fontana G, et al. Complete percutaneous approach for arterial access in transfemoral transcatheter aortic valve replacement: a comparison with surgical cut-down and closure. Catheter Cardiovasc Interv. 2014;84(2):293–300. https://doi.org/10.1002/ccd.25130.CrossRefPubMed

15.

DuBose JJ, Scalea TM, Brenner M, Skiada D, Inaba K, Cannon J, et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016;81(3):409–19. https://doi.org/10.1097/TA.0000000000001079.CrossRefPubMed

16.

Morrison JJ, Galgon RE, Jansen JO, Cannon JW, Rasmussen TE, Eliason JL. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016;80(2):324–34. https://doi.org/10.1097/TA.0000000000000913.CrossRefPubMed

17.

Teeter WA, Matsumoto J, Idoguchi K, Kon Y, Orita T, Funabiki T, et al. Smaller introducer sheaths for REBOA may be associated with fewer complications. J Trauma Acute Care Surg. 2016;81(6):1039–45. https://doi.org/10.1097/TA.0000000000001143.CrossRefPubMed

18.

Khan MZ, Bruce J, Baer D, Hoencamp R. Hybrid use of REBOA in a South African tertiary trauma unit for penetrating torso trauma. BMJ Case Rep. 2019. https://doi.org/10.1136/bcr-2019-229538.CrossRefPubMedPubMedCentral

19.

Sovik E, Stokkeland P, Storm BS, Asheim P, Bolas O. The use of aortic occlusion balloon catheter without fluoroscopy for life-threatening post-partum haemorrhage. Acta Anaesthesiol Scand. 2012;56(3):388–93. https://doi.org/10.1111/j.1399-6576.2011.02611.x.CrossRefPubMed

20.

Linnebur M, Inaba K, Haltmeier T, Rasmussen TE, Smith J, Mendelsberg R, et al. Emergent non-image-guided resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter placement: a cadaver-based study. J Trauma Acute Care Surg. 2016;81(3):453–7. https://doi.org/10.1097/TA.0000000000001106.CrossRefPubMed

21.

Okada Y, Narumiya H, Ishi W, Iiduka R. Anatomical landmarks for safely implementing resuscitative balloon occlusion of the aorta (REBOA) in zone 1 without fluoroscopy. Scand J Trauma Resusc Emerg Med. 2017;25(1):63. https://doi.org/10.1186/s13049-017-0411-z.CrossRefPubMedPubMedCentral

22.

MacTaggart JN, Poulson WE, Akhter M, Seas A, Thorson K, Phillips NY, et al. Morphometric roadmaps to improve accurate device delivery for fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2016;80(6):941–6. https://doi.org/10.1097/TA.0000000000001043.CrossRefPubMedPubMedCentral

23.

Morrison JJ, Stannard A, Midwinter MJ, Sharon DJ, Eliason JL, Rasmussen TE. Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system. Surgery. 2014;155(6):1044–51. https://doi.org/10.1016/j.surg.2013.12.036.CrossRefPubMed

24.

Pezy P, Flaris AN, Prat NJ, Cotton F, Lundberg PW, Caillot JL, et al. Fixed-distance model for balloon placement during fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta in a civilian population. JAMA Surg. 2017;152(4):351–8. https://doi.org/10.1001/jamasurg.2016.4757.CrossRefPubMedPubMedCentral

Title: A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care
Authors: Suzanne M. Vrancken
Boudewijn L. S. Borger van der Burg
Paul J. E. M. Vrancken
Gert-Aldert H. Kock
Todd E. Rasmussen
Rigo Hoencamp
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 1/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01382-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

The effect of socioeconomic status on severe traumatic injury: a statistical analysis

Is there a correlation between fragility fractures of the pelvis (FFP) and the morphology of the true pelvis in geriatric patients?

Selecting the right limb, at the right time, for the right reason: response to “A meta-analysis on anticoagulation after vascular trauma”

Professional practice assessment: establishment of an institutional procedure to treat blunt abdominal trauma in emergency pediatric department

Intraosseous access in the resuscitation of trauma patients: a literature review

Focus on fragility fractures of the pelvis