Deployment of second-generation resuscitative endovascular balloon occlusion of the aorta for unresponsive hypotension in a polytrauma patient

Deployment of second-generation resuscitative endovascular balloon occlusion of the aorta for unresponsive hypotension in a polytrauma patient

Can J Surg 2019;62(2):142-144 | PDF

Tiffany Paradis, BSc; Omar Bekdache, MD; David Bracco, MD; Jeremy Grushka, MD, MSc; Tarek Razek, MD; David Lasry, MD; Andrew Beckett, MD, MSc

Summary

Noncompressible hemorrhagic control remains one of the most challenging areas in damage control medicine and continues to be a leading cause of preventable death. For decades, emergency thoracotomy or laparotomy and aortic cross clamping have remained the gold standard intervention. Recently, there has been a movement toward less invasive techniques for noncompressible hemorrhagic control, such as resuscitative endovascular balloon occlusion of the aorta (REBOA). The REBOA technique involves inflation of an endovascular balloon within the abdominal aorta proximal to the vascular injury to temporarilyinhibit bleeding. Although the literature is robust on this new technique, skepticism remains about whether REBOA is superior to aortic cross clamping, as it has been associated with complications including organ and limb ischemia, limb amputation, femoral aneurysm, and thrombosis.


Accepted July 27, 2018

Acknowledgements: The authors acknowledge the generous support of the Montreal General Hospital Foundation, and the McGill University Health Centre Emergency Medicine and Adult Trauma Programs.

Affiliations: From the Faculty of Medicine McGill University, Montreal, Que. (Paradis); the Trauma Program, McGill University Health Centre, Montreal, Que, (Bekdache, Bracco, Grushka, Razek, Lasry, Beckett); and the Royal Canadian Medical Services, Montreal, Que. (Beckett).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.007618

Correspondence to: O. Bekdache, Montreal General Hospital, 1650 Cedar Ave., Montreal QC H3G 1A4, omar.bekdache@mail.mcgill.ca