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The Novel Use of Resuscitative Endovascular Balloon Occlusion of the Aorta to Explore a Retroperitoneal Hematoma in a Hemodynamically Unstable Patient.

Abstract Balloon occlusion of the aorta was first described by C.W. Hughes in 1954, when it was used as a tamponade device for three wounded soldiers during the Korean War suffering from intra-abdominal hemorrhage. Currently, the device is indicated in trauma patients as a surrogate for resuscitative thoracotomy. Brenner et al. reported a case series describing the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in advanced hemorrhagic shock. Their conclusion was that "it is a feasible method for proximal aortic control." We describe the novel use of REBOA before retroperitoneal hematoma exploration in a hemodynamically unstable patient. Reported is a 19-year-old blunt trauma victim where REBOA was successfully deployed as a means for proximal arterial control before a Zone 1 retroperitoneal hematoma exploration. The source of the patient's hemorrhagic shock was multifactorial: grade V hepatic injury, retrohepatic inferior vena cava laceration, and right renal vein avulsion with Zone 1 retroperitoneal hematoma. Immediate return of perfusion pressure, as systolic pressures increased from 50 to 150 mm Hg. Hemodynamic improvements were accompanied by decreased transfusion and vasopressor requirements. In addition, the surgeons were able to enter the retroperitoneal hematoma under controlled conditions. REBOA is an attractive new tool to gain proximal aortic control in select patients with hemorrhagic shock. It is less morbid, possibly more efficient, and appears to be more effective than resuscitative thoracotomy. REBOA is certainly feasible for proximal aortic control before retroperitoneal exploration, and should be considered in select patients.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the american surgeon
Publication Year Start




PMID- 28424126
OWN - NLM
STAT- MEDLINE
DA  - 20170420
DCOM- 20170501
LR  - 20170501
IS  - 1555-9823 (Electronic)
IS  - 0003-1348 (Linking)
VI  - 83
IP  - 4
DP  - 2017 Apr 01
TI  - The Novel Use of Resuscitative Endovascular Balloon Occlusion of the Aorta to
      Explore a Retroperitoneal Hematoma in a Hemodynamically Unstable Patient.
PG  - 337-340
AB  - Balloon occlusion of the aorta was first described by C.W. Hughes in 1954, when
      it was used as a tamponade device for three wounded soldiers during the Korean
      War suffering from intra-abdominal hemorrhage. Currently, the device is indicated
      in trauma patients as a surrogate for resuscitative thoracotomy. Brenner et al.
      reported a case series describing the use of resuscitative endovascular balloon
      occlusion of the aorta (REBOA) in advanced hemorrhagic shock. Their conclusion
      was that "it is a feasible method for proximal aortic control." We describe the
      novel use of REBOA before retroperitoneal hematoma exploration in a
      hemodynamically unstable patient. Reported is a 19-year-old blunt trauma victim
      where REBOA was successfully deployed as a means for proximal arterial control
      before a Zone 1 retroperitoneal hematoma exploration. The source of the patient's
      hemorrhagic shock was multifactorial: grade V hepatic injury, retrohepatic
      inferior vena cava laceration, and right renal vein avulsion with Zone 1
      retroperitoneal hematoma. Immediate return of perfusion pressure, as systolic
      pressures increased from 50 to 150 mm Hg. Hemodynamic improvements were
      accompanied by decreased transfusion and vasopressor requirements. In addition,
      the surgeons were able to enter the retroperitoneal hematoma under controlled
      conditions. REBOA is an attractive new tool to gain proximal aortic control in
      select patients with hemorrhagic shock. It is less morbid, possibly more
      efficient, and appears to be more effective than resuscitative thoracotomy. REBOA
      is certainly feasible for proximal aortic control before retroperitoneal
      exploration, and should be considered in select patients.
FAU - Rosenthal, Martin D
AU  - Rosenthal MD
FAU - Raza, Ahsan
AU  - Raza A
FAU - Markle, Stephanie
AU  - Markle S
FAU - Croft, Chasen A
AU  - Croft CA
FAU - Mohr, Alicia M
AU  - Mohr AM
FAU - Smith, R Stephen
AU  - Smith RS
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Am Surg
JT  - The American surgeon
JID - 0370522
SB  - IM
MH  - Accidents, Traffic
MH  - Aorta, Abdominal/*injuries
MH  - Balloon Occlusion/*methods
MH  - Fatal Outcome
MH  - Hematoma/*therapy
MH  - Hemodynamics
MH  - Hemoperitoneum/*therapy
MH  - Humans
MH  - Liver/injuries
MH  - Male
MH  - Resuscitation/*methods
MH  - Shock, Hemorrhagic/*therapy
MH  - Vena Cava, Inferior/injuries
MH  - Young Adult
EDAT- 2017/04/21 06:00
MHDA- 2017/05/02 06:00
CRDT- 2017/04/21 06:00
PST - ppublish
SO  - Am Surg. 2017 Apr 1;83(4):337-340.

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