Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Noncompressible Torso Hemorrhage
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Published:2021-06-04
Issue:2
Volume:4
Page:
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ISSN:2002-7567
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Container-title:Journal of Endovascular Resuscitation and Trauma Management
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language:
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Short-container-title:JEVTM
Author:
Roberts Derek Jason,Cotton Bryan A.,Duchesne Juan,Ferrada Paula,Horer Tal M.,Kauvar David,Khan Mansoor,Kirkpatrick Andrew W.,Ordoñez Carlos,Perreira Bruno,Priouzram Artai,Brenner Megan L.
Abstract
Non-compressible torso haemorrhage (NCTH) (i.e., bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this manuscript, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude the above by providing recommendations as to when each of these methods may be best when indicated to manage injured patients with NCTH.
Publisher
Orebro Univeirsty Hospital, EVTM Program
Subject
Critical Care and Intensive Care Medicine,Emergency Medicine,Surgery