PMID- 31010604
OWN - NLM
STAT- MEDLINE
DCOM- 20200330
LR  - 20200330
IS  - 0736-4679 (Print)
IS  - 0736-4679 (Linking)
VI  - 56
IP  - 6
DP  - 2019 Jun
TI  - Resuscitative Endovascular Balloon Occlusion of the Aorta: A Review for Emergency 
      Clinicians.
PG  - 687-697
LID - S0736-4679(19)30237-9 [pii]
LID - 10.1016/j.jemermed.2019.03.030 [doi]
AB  - BACKGROUND: Non-compressible torso hemorrhage (NCTH) is difficult to control and 
      associated with significant mortality. Resuscitative endovascular balloon 
      occlusion of the aorta (REBOA) utilizes an infra-diaphragmatic approach to 
      control NCTH and is less invasive than resuscitative thoracotomy (RT). This 
      article highlights the evidence for REBOA and provides an overview of the 
      indications, procedural steps, and complications in adults for emergency 
      clinicians. DISCUSSION: Traumatic hemorrhage can be life threatening. Patients in 
      extremis, whether from NCTH or exsanguination from other sites, may require RT 
      with aortic cross-clamping. REBOA offers another avenue for proximal hemorrhage 
      control and can be completed by emergency clinicians. The American College of 
      Surgeons Committee on Trauma and the American College of Emergency Physicians 
      recently released a joint statement detailing the indications for REBOA in 
      adults. The evidence behind its use remains controversial, with significant 
      heterogeneity among studies. Most studies demonstrate improved blood pressure 
      without a significant improvement in mortality. Procedural steps include arterial 
      access (most commonly the common femoral artery), positioning the initial sheath, 
      balloon preparation and positioning, balloon inflation, securing the 
      balloon/sheath, subsequent hemorrhage control, balloon deflation, and 
      balloon/sheath removal. Several major complications can occur with REBOA 
      placement. Future studies should evaluate training protocols, the role of 
      simulation, and which target populations would benefit most from REBOA. 
      CONCLUSIONS: REBOA can provide proximal hemorrhage control and can be performed 
      by emergency clinicians. This article evaluates the evidence, indications, 
      procedure, and complications for emergency clinicians.
CI  - Published by Elsevier Inc.
FAU - Long, Brit
AU  - Long B
AD  - Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, 
      Texas.
FAU - Hafen, Lee
AU  - Hafen L
AD  - Department of General Surgery, Brooke Army Medical Center, Fort Sam Houston, 
      Texas.
FAU - Koyfman, Alex
AU  - Koyfman A
AD  - Department of Emergency Medicine, The University of Texas Southwestern Medical 
      Center, Dallas, Texas.
FAU - Gottlieb, Michael
AU  - Gottlieb M
AD  - Department of Emergency Medicine, Rush University Medical Center, Chicago, 
      Illinois.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20190419
PL  - United States
TA  - J Emerg Med
JT  - The Journal of emergency medicine
JID - 8412174
SB  - IM
MH  - Aorta/anatomy & histology/*injuries/physiopathology
MH  - Balloon Occlusion/*methods/trends
MH  - Emergency Medical Services/methods
MH  - Endovascular Procedures/education/*methods
MH  - Humans
MH  - Resuscitation/education/*methods
OTO - NOTNLM
OT  - REBOA
OT  - aortic occlusion
OT  - balloon
OT  - catheter
OT  - complication
OT  - hemorrhage
OT  - junctional hemorrhage
OT  - resuscitative endovascular balloon occlusion of the aorta
EDAT- 2019/04/24 06:00
MHDA- 2020/03/31 06:00
CRDT- 2019/04/24 06:00
PHST- 2019/01/17 00:00 [received]
PHST- 2019/02/25 00:00 [revised]
PHST- 2019/03/16 00:00 [accepted]
PHST- 2019/04/24 06:00 [pubmed]
PHST- 2020/03/31 06:00 [medline]
PHST- 2019/04/24 06:00 [entrez]
AID - S0736-4679(19)30237-9 [pii]
AID - 10.1016/j.jemermed.2019.03.030 [doi]
PST - ppublish
SO  - J Emerg Med. 2019 Jun;56(6):687-697. doi: 10.1016/j.jemermed.2019.03.030. Epub 
      2019 Apr 19.