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Hörer, Tal M.
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van der Burg, B. L., Kessel, B., DuBose, J. J., Hörer, T. M. & Hoencamp, R. (2019). Consensus on resuscitative endovascular balloon occlusion of the Aorta: A first consensus paper using a Delphi method. Injury, 50(6), 1186-1191
Open this publication in new window or tab >>Consensus on resuscitative endovascular balloon occlusion of the Aorta: A first consensus paper using a Delphi method
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2019 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 50, no 6, p. 1186-1191Article in journal (Refereed) Published
Abstract [en]

Background: To further strengthen the evidence base on the use of Resuscitative Endovascular Balloon occlusion of the Aorta (REBOA) we performed a Delphi consensus. The aim of this paper is to establish consensus on the indications and contraindications for the use of REBOA in trauma and non-trauma patients based on the existing evidence and expertise.

Study Design: A literature review facilitated the design of a three-round Delphi questionnaire. Delphi panelists were identified by the investigators. Consensus was reached when at least 70% of the panelists responded to the survey and more than 70% of respondents reached agreement or disagreement.

Results: Panel members reached consensus on potential indications, contra-indications and settings for use of REBOA (excluding the pre hospital environment), physiological parameters for patient selection and indications for early femoral access. Panel members failed to reach consensus on the use of REBOA in patients in extremis (no pulse, no blood pressure) and the use of REBOA in patients with two major bleeding sites.

Conclusions: Consensus was reached on indications, contra indications, physiological parameters for patient selection for REBOA and early femoral access. The panel did not reach consensus on the use of REBOA in patients in pre-hospital settings, patients in extremis (no pulse, no blood pressure) and in patients with 2 or more major bleeding sites. Further research should focus on the indications of REBOA in pre hospital settings, patients in near cardiac arrest and REBOA inflation times.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
REBOA, Delphi consensus, Indications, contra indications
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-75247 (URN)10.1016/j.injury.2019.04.024 (DOI)000470813800005 ()31047681 (PubMedID)2-s2.0-85064740177 (Scopus ID)
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Duchesne, J., Tatum, D., Hörer, T. M., Nilsson, K. F., McGreevy, D., DuBose, J. & Brenner, M. (2019). IMPACT OF DELTA SYSTOLIC BLOOD PRESSURE AFTER REBOA PLACEMENT IN NON-COMPRESSIBLE TORSO HEMORRHAGE PATIENTS: AN ABOTRAUMA REGISTRY ANALYSIS. Paper presented at 42nd Annual Conference on Shock, Coronado, CA, USA, June 8-11, 2019,. Shock, 51(6), 159-159
Open this publication in new window or tab >>IMPACT OF DELTA SYSTOLIC BLOOD PRESSURE AFTER REBOA PLACEMENT IN NON-COMPRESSIBLE TORSO HEMORRHAGE PATIENTS: AN ABOTRAUMA REGISTRY ANALYSIS
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2019 (English)In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 51, no 6, p. 159-159Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-75966 (URN)000480793600343 ()
Conference
42nd Annual Conference on Shock, Coronado, CA, USA, June 8-11, 2019,
Available from: 2019-08-29 Created: 2019-08-29 Last updated: 2019-08-29Bibliographically approved
McGreevy, D. T., Dogan, S., Oscarsson, V., Vergari, M., Eliasson, K., Hörer, T. M., . . . Norgren, L. (2019). Metabolic Response to Claudication in Peripheral Arterial Disease: a Microdialysis pilot study. Annals of Vascular Surgery, 58, 134-141
Open this publication in new window or tab >>Metabolic Response to Claudication in Peripheral Arterial Disease: a Microdialysis pilot study
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2019 (English)In: Annals of Vascular Surgery, ISSN 0890-5096, E-ISSN 1615-5947, Vol. 58, p. 134-141Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In a pilot study investigate the possible use of microdialysis in the calf muscle to assess the metabolic response to intermittent claudication (IC). In addition, evaluate the simultaneous systemic inflammatory reaction.

METHODS: With one microdialysis catheter in the gastrocnemic muscle and one subcutaneously in the pectoral region (as a reference), and a peripheral venous catheter, dialysate and venous blood sampling was performed before, during and after walking on a treadmill to maximal tolerable claudication (controls 10 minutes).

RESULTS: A total of 9 participants were recruited, six patients with IC and three healthy controls. At baseline, IC and control subjects did not differ in metabolic findings (glucose, lactate, pyruvate, glycerol) in the gastrocnemic muscle. Subcutaneous glucose concentration was higher in controls. After physical exertion, gastrocnemic and subcutaneous glycerol, lactate and pyruvate concentrations increased in IC subjects. Plasma concentrations of Tumor Necrosis Factor--α (TNF- α), Interleucin-6 (IL-6), Interleucin-1ß (IL-1ß), Hepatocyte Growth Factor (HGF) and Vascular Endothelial Growth Factor (VEGF) were higher in IC subjects at baseline, and TNF-α, (IL-6) and Interleukin-18 (IL-18) increased after walking as did IL-6 and (IL-1ß) in controls. The muscle catheters did not show any signs of causing harm.

CONCLUSIONS: Microdialysis can be used to study the ongoing metabolic response during walking and claudication. Our results suggest both an acute local and a systemic inflammatory reaction during development of claudication pain.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Intermittent Claudication, Microdialysis, Peripheral Arterial Disease, Skeletal muscle
National Category
Physiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-71845 (URN)10.1016/j.avsg.2018.09.041 (DOI)000472166800018 ()30684623 (PubMedID)2-s2.0-85062659237 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-08-08Bibliographically approved
Oikonomakis, I., Jansson, D., Hörer, T. M., Skoog, P., Nilsson, K. F. & Jansson, K. (2019). Results of postoperative microdialysis intraperitoneal and at the anastomosis in patients developing anastomotic leakage after rectal cancer surgery. Scandinavian Journal of Gastroenterology, 54(10), 1261-1268
Open this publication in new window or tab >>Results of postoperative microdialysis intraperitoneal and at the anastomosis in patients developing anastomotic leakage after rectal cancer surgery
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2019 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 54, no 10, p. 1261-1268Article in journal (Refereed) Published
Abstract [en]

Introduction: Anastomotic leakage postoperatively in patients operated with rectum resection and primary anastomosis is a common and feared complication. We have studied seven patients with an anastomotic leakage after surgery and compared them with 13 patients without complications.

Methods: Metabolic measurements with microdialysis were done during the first seven postoperative days, with measurements of glucose, pyruvate, lactate and glycerol. The lactate/pyruvate ratio was calculated. Measurements were performed subcutaneously, intraperitoneally and at the anastomosis. The inflammatory cytokines, IL 6 and IL 10, were measured intravenously and intraperitoneally 48 hours postoperatively.

Results: Intravenous and intraperitoneal IL 6 were higher in the leakage group. Around the small intestine (intraperitoneally), we found that patients developing anastomotic leakage had higher lactate and lactate/pyruvate ratio immediately after surgery. They also showed lower glycerol levels. At the anastomosis, we found higher lactate and lactate/pyruvate ratio in anastomotic leak patients after the fourth postoperative day.

Conclusions: The results indicate that a possible mechanism behind an anastomotic leakage is an impaired circulation and thus insufficient saturation to the small intestine peroperatively. This develops into an inflammation both intraperitoneally and intravenously, which, if not reversed, spread within the gastrointestinal tract. The colorectal anastomosis is the most vulnerable part of the gastrointestinal tract postoperatively and hypoxia and inflammation may occur there, and an anastomosis leakage will be the consequence.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Rectal surgery, anastomotic leakage, intraperitoneal microdialysis, lactate pyruvate ratio, intraperitoneal cytokines
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:oru:diva-77758 (URN)10.1080/00365521.2019.1673476 (DOI)000491462900001 ()31630578 (PubMedID)
Note

Funding Agencies:

Research Committee of Region Örebro County at Örebro University Hospital  

Nyckelfonden at Örebro University Hospital 

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-21Bibliographically approved
Dogan, E. M., Beskow, L., Calais, F., Hörer, T. M., Axelsson, B. & Nilsson, K. F. (2019). Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters. Shock, 52(1), 67-74
Open this publication in new window or tab >>Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation: Aortic Occlusion Level Matters
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2019 (English)In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 52, no 1, p. 67-74Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.

HYPOTHESIS: The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.

METHODS: Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.

RESULTS: During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71-101) to 128 mmHg (CI 107-150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).

CONCLUSIONS: Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid-base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
Keywords
Cardiac arrest, cardiopulmonary resuscitation, hemodynamics, metabolism, resuscitative endovascular balloon occlusion of the aorta, return of spontaneous circulation
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-75674 (URN)10.1097/SHK.0000000000001236 (DOI)000480796100010 ()30067564 (PubMedID)2-s2.0-85067806297 (Scopus ID)
Funder
Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

Research Committee of Region Örebro County 

Nyckelfonden, at Örebro University Hospital  

ALF Grants (Agreement concerning research and education of doctors)  

Region Örebro County 

Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-11-15Bibliographically approved
Wikström, M., Krantz, J., Hörer, T. M. & Nilsson, K. F. (2019). Resuscitative endovascular balloon occlusion of the inferior vena cava is made hemodynamically possible by concomitant endovascular balloon occlusion of the aorta: a porcine study. Journal of Trauma and Acute Care Surgery
Open this publication in new window or tab >>Resuscitative endovascular balloon occlusion of the inferior vena cava is made hemodynamically possible by concomitant endovascular balloon occlusion of the aorta: a porcine study
2019 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Resuscitative endovascular balloon occlusion of the vena cava inferior (REBOVC) may provide a minimal invasive alternative for hepatic vascular and inferior vena cava isolation in severe retrohepatic bleeding. However, circulatory stability may be compromised by the obstruction of venous return. The aim was to explore which combinations of arterial and venous endovascular balloon occlusions, and the Pringle maneuver, are hemodynamically possible in a normovolemic pig model. The hypothesis was that lower body venous blood pooling from REBOVC can be avoided by prior resuscitative endovascular aortic balloon occlusion (REBOA).

METHODS: Nine anesthetized, ventilated, instrumented and normovolemic pigs were used to explore the hemodynamic effects of eleven combinations of REBOA and REBOVC, with or without the Pringle maneuver, in randomized order. The occlusions were performed for 5 minutes but interrupted if systolic blood pressure dropped below 40 mmHg. Hemodynamic variables were measured.

RESULTS: Proximal REBOVC, isolated or in combination with other methods of occlusion, caused severely decreased systemic blood pressure and cardiac output, and had to be terminated before 5 min. The decreases in systemic blood pressure and cardiac output were avoided by REBOA at the same or a more proximal level. The Pringle maneuver had similar hemodynamic effects to proximal REBOVC.

CONCLUSIONS: A combination of REBOA and REBOVC provides hemodynamic stability, in contrast to REBOVC alone or with the Pringle maneuver, and may be a possible adjunct in severe retrohepatic venous bleedings.Level of evidenceBasic science study, therapeutic.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-75810 (URN)10.1097/TA.0000000000002467 (DOI)31397743 (PubMedID)
Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-23Bibliographically approved
Seilitz, J., Hörer, T. M., Skoog, P., Sadeghi, M., Jansson, K., Axelsson, B. & Nilsson, K. F. (2019). Splanchnic Circulation and Intraabdominal Metabolism in Two Porcine Models of Low Cardiac Output. Journal of Cardiovascular Translational Research, 12(3), 240-249
Open this publication in new window or tab >>Splanchnic Circulation and Intraabdominal Metabolism in Two Porcine Models of Low Cardiac Output
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2019 (English)In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 12, no 3, p. 240-249Article in journal (Refereed) Published
Abstract [en]

The impact of acute cardiac dysfunction on the gastrointestinal tract was investigated in anesthetized and instrumented pigs by sequential reductions of cardiac output (CO). Using a cardiac tamponade (n = 6) or partial inferior caval vein balloon inflation (n = 6), CO was controllably reduced for 1 h each to 75% (CO75%), 50% (CO50%), and 35% (CO35%) of the baseline value. Cardiac output in controls (n = 6) was not manipulated and maintained. Mean arterial pressure, superior mesenteric arterial blood flow, and intestinal mucosal perfusion started to decrease at CO50% in the intervention groups. The decrease in superior mesenteric arterial blood flow was non-linear and exaggerated at CO35%. Systemic, venous mesenteric, and intraperitoneal lactate concentrations increased in the intervention groups from CO50%. Global and mesenteric oxygen uptake decreased at CO35%. In conclusion, gastrointestinal metabolism became increasingly anaerobic when CO was reduced by 50%. Anaerobic gastrointestinal metabolism in low CO can be detected using intraperitoneal microdialysis.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Cardiac dysfunction, Cardiac tamponade, Caval vein balloon, Intraperitoneal microdialysis, Laser Doppler flowmetry, Porcine model
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-70279 (URN)10.1007/s12265-018-9845-6 (DOI)000474567100009 ()30456737 (PubMedID)2-s2.0-85056828149 (Scopus ID)
Funder
Swedish Society for Medical Research (SSMF)
Note

Funding Agencies:

Research Committee of Region Örebro County  

Nyckelfonden at Örebro University Hospital  

ALF Grants (Agreement concerning research and education of doctors) at Region Örebro County 

Available from: 2018-11-22 Created: 2018-11-22 Last updated: 2019-11-08Bibliographically approved
van der Burg, B. L. S., Hörer, T. M., Eefting, D., van Dongen, T. T., Hamming, J. F., DuBose, J. J., . . . Hoencamp, R. (2019). Vascular access training for REBOA placement: a feasibility study in a live tissue-simulator hybrid porcine model. Journal of the Royal Army Medical Corps, 165(3), 147-151
Open this publication in new window or tab >>Vascular access training for REBOA placement: a feasibility study in a live tissue-simulator hybrid porcine model
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2019 (English)In: Journal of the Royal Army Medical Corps, ISSN 0035-8665, E-ISSN 2052-0468, Vol. 165, no 3, p. 147-151Article in journal (Refereed) Published
Abstract [en]

Background: The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with severe haemorrhagic shock is increasing. Obtaining vascular access is a necessary prerequisite for REBOA placement in these situations.

Methods: During the EVTM workshop (September 2017, Orebro, Sweden), 21 individuals participated in this study, 16 participants and five instructors. A formalised curriculum was constructed including basic anatomy of the femoral region and basic training in access materials for REBOA placement in zone 1. Key skills: (1) preparation of endovascular toolkit, (2) achieving vascular access in the model and (3) bleeding control with REBOA. Scoring ranged from 0 to 5 for non-anatomical skills. Identification of anatomical structures was either sufficient (score=1) or insufficient (score=0). Five consultants performed a second identical procedure as a post test.

Results: Consultants had significantly better overall technical skills in comparison with residents (p=0.005), while understanding of surgical anatomy showed no difference. Procedure times differed significantly (p<0.01), with residents having a median procedure time of 3 min and 24 s, consultants 2:33 and instructors 1:09.

Conclusion: This comprehensive training model using a live tissue-simulator hybrid porcine model can be used for femoral access and REBOA placement training in medical personnel with different prior training levels. Higher levels of training are associated with faster procedure times. Further research in open and percutaneous access training is necessary to simulate real-life situations. This training method can be used in a multistep training programme, in combination with realistic moulage and perfused cadaver models.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
General Practice Surgery
Identifiers
urn:nbn:se:oru:diva-75245 (URN)10.1136/jramc-2018-000972 (DOI)000471092200004 ()30228195 (PubMedID)2-s2.0-85053716869 (Scopus ID)
Note

Funding Agency:

Prytime Medical Devices, Inc. 

Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Manzano-Nunez, R., Orlas, C. P., Herrera-Escobar, J. P., Galvagno, S., DuBose, J., Melendez, J. J., . . . Ordoñez, C. A. (2018). A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients.. Journal of Trauma and Acute Care Surgery, 85(3), 626-634
Open this publication in new window or tab >>A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients.
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2018 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 85, no 3, p. 626-634Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult trauma patients.

METHODS: We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult trauma patients that underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed RESULTS: We 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients respectively. Overall, complications related to groin access occurred in 5.6% of patients (n=24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis which used the logit transformation showed a 5% (95% CI 3%-9%) incidence of complications without significant heterogeneity (LR test: χ2 = 0.73, p=0.2, Tau-square=0.2). In a second meta-analysis, we used the Freeman-Turkey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%-7%) with low heterogeneity (I2 = 16.3%).

CONCLUSION: We found that the incidence of complications related to groin access was of four to five percent based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery.

LEVEL OF EVIDENCE: Systematic Review and Meta-analysis, Level III.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
Wounds and injuries, REBOA, endovascular procedures, intraoperative complications, benchmarking
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-67103 (URN)10.1097/TA.0000000000001978 (DOI)000443539800027 ()29787536 (PubMedID)2-s2.0-85052739748 (Scopus ID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-09-24Bibliographically approved
Borger van der Burg, B. L., van Dongen, T. T. C., Morrison, J. J., Hedeman Joosten, P. P., DuBose, J. J., Hörer, T. M. & Hoencamp, R. (2018). A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. European Journal of Trauma and Emergency Surgery, 44(4), 535-550
Open this publication in new window or tab >>A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination
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2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 535-550Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.

METHODS: Systematic review and meta-analysis (1900-2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords "aortic balloon occlusion", "aortic balloon tamponade", "REBOA", and "Resuscitative Endovascular Balloon Occlusion" in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.

RESULTS: A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.

CONCLUSION: REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2018
Keywords
Aortic balloon occlusion, Endovascular, REBOA, Shock, Trauma
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-67105 (URN)10.1007/s00068-018-0959-y (DOI)000440981100007 ()29785654 (PubMedID)2-s2.0-85047217050 (Scopus ID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-08-22Bibliographically approved
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