Successfully REBOA Performance: Does Medical Specialty Matter? International Data From the ABOTrauma Registry.
Background
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?”.
Methods
Data from the international ABO (Aortic Balloon Occlusion) Trauma registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients.
Results
During the study period, 259 patients had been recorded in the registry, 72.5% (n=188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5% and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common Femoral Artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cut down in 57 patients (24%), using ultrasound in 49 patients (21%) and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room and mortality.
Conclusion
A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cut down is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”.
Figure 1
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Posted 17 Sep, 2020
On 23 Nov, 2020
On 23 Nov, 2020
Received 26 Sep, 2020
Received 24 Sep, 2020
On 16 Sep, 2020
Invitations sent on 14 Sep, 2020
On 14 Sep, 2020
On 14 Sep, 2020
On 13 Sep, 2020
On 12 Sep, 2020
On 12 Sep, 2020
On 11 Sep, 2020
Successfully REBOA Performance: Does Medical Specialty Matter? International Data From the ABOTrauma Registry.
Posted 17 Sep, 2020
On 23 Nov, 2020
On 23 Nov, 2020
Received 26 Sep, 2020
Received 24 Sep, 2020
On 16 Sep, 2020
Invitations sent on 14 Sep, 2020
On 14 Sep, 2020
On 14 Sep, 2020
On 13 Sep, 2020
On 12 Sep, 2020
On 12 Sep, 2020
On 11 Sep, 2020
Background
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?”.
Methods
Data from the international ABO (Aortic Balloon Occlusion) Trauma registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients.
Results
During the study period, 259 patients had been recorded in the registry, 72.5% (n=188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5% and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common Femoral Artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cut down in 57 patients (24%), using ultrasound in 49 patients (21%) and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room and mortality.
Conclusion
A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cut down is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”.
Figure 1