To Örebro University

Massive bleeding is a significant health care challenge, particularly in the case of non-compressible torso hemorrhage, with both traumatic and non-traumatic causes. The management of bleeding in the torso poses unique challenges, both anatomically and physiologically. The concept of Endo-Vascular resuscitation and Trauma Management (EVTM) has evolved alongside endovascular surgery over the past two decades. It combines modern endovascular surgical techniques with traditional open surgical management to provide early evaluation, resuscitation, and definitive treatment of both traumatic and non-traumatic bleeding patients. The purpose of this thesis was to investigate the feasibility, outcomes and practice patterns of EVTM in patients with hemodynamic instability.

Study I was a retrospective cohort study assessing the consecutive use of Endovascular Aortic Repair (EVAR) for all 100 patients with ruptured ab-dominal aortic aneurysms (rAAA). Mortality at 30 days was 27% with a turndown rate of 3.5%.

Study II was a retrospective cohort study examining the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with impending traumatic cardiac arrest showing that vascular access is feasible and REBOA increases systolic blood pressure (SBP).

Study III & IV were animal experimental studies evaluating the use of RE-BOA for hemodynamic instability due to intrathoracic bleeding or acute cardiac tamponade. They showed that REBOA, using different occlusion techniques, maintains permissive hypotension, carotid blood flow and prolongs survival.

Study V was a retrospective cohort study comparing outcomes and practice patterns for patients with grade 3 or 4 blunt thoracic aortic injury (BTAI) treated with TEVAR. Hemodynamically unstable patients have increased risk of complications, prolonged length of hospital stay and increased levels of in-hospital mortality.