Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report View Full Text


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Article Info

DATE

2019-06-24

AUTHORS

Orkun Özkurtul, Holger Staab, Georg Osterhoff, Benjamin Ondruschka, Andreas Höch, Christoph Josten, Johannes Karl Maria Fakler

ABSTRACT

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective adjunct in hemodynamic unstable patients with uncontrolled and non-compressible torso hemorrhage promoting temporary stability during injury repair. The aim of our study was to analyze real life usability of REBOA based on a case report and to review the literature with respect to its possibilities and limitations.Case presentationWe present the case of a 17-years old female patient who sustained a severe roll-over trauma and pelvic crush injury as a bicyclist by a truck. Upon arrival of the first responders, the patient was awake, alert, and following commands.Subsequent to lifting the truck, the patient became hypotensive and required cardiopulmonary resuscitation, application of a pelvic binder, and endotracheal intubation at the accident scene. She was then admitted by ambulance to our trauma center under ongoing resuscitative measures. After primary survey, it was decided to perform a REBOA with surgical approach to the left femoral artery. Initial insertion of the catheter was successful but could not be advanced beyond the inguinal region. Hence, the patient was transferred to the operating room (OR) but died despite maximum therapy. In the OR and later autopsy, we found a long-distance ruptured and dehiscent external iliac artery with massive bleeding into the pelvis in the context of a bilateral vertical shear fractured pelvic bone.ConclusionREBOA can be a useful adjunct but there is a major limitation with potential vascular injury after pelvic trauma. In these situations, cross-clamping the proximal aorta or pre-peritoneal pelvic packing as “traditional” approaches of hemorrhage control during resuscitation may be the most considerable methods for temporary stabilization in severely injured trauma patients. More clinical and cadaveric studies are needed to further understand indications and limitations of REBOA after severe pelvic trauma. More... »

PAGES

25

References to SciGraph publications

  • 2017-07-14. A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients in WORLD JOURNAL OF EMERGENCY SURGERY
  • 2018-10-25. Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study in WORLD JOURNAL OF EMERGENCY SURGERY
  • 2016-02-09. Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting in SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE
  • 2016-11-10. Lower limb ischemia caused by resuscitative balloon occlusion of aorta in SURGICAL CASE REPORTS
  • 2018-03-05. „Resuscitative endovascular balloon occlusion of the aorta“ in DIE ANAESTHESIOLOGIE
  • 2018-05-11. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in WORLD JOURNAL OF EMERGENCY SURGERY
  • 2018-05-21. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination in EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
  • 2016-05-16. Erratum to: Resuscitative endovascular balloon occlusion of the aorta for uncontrolled haemorrahgic shock as an adjunct to haemostatic procedures in the acute care setting in SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE
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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/31285757


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