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. 2021 Aug 1;91(2):295-301.
doi: 10.1097/TA.0000000000003198.

Strategies for successful implementation of resuscitative endovascular balloon occlusion of the aorta in an urban Level I trauma center

Jamie B Hadley  1 , Julia R Coleman, Ernest E Moore, Ryan Lawless, Clay C Burlew, Barry Platnick, Fredric M Pieracci, Melanie R Hoehn, Jamie J Coleman, Eric M Campion, Mitchell J Cohen, Alexis Cralley, Andrew P Eitel, Matthew Bartley, Navin Vigneshwar, Angela Sauaia, Charles J Fox
Affiliations

Strategies for successful implementation of resuscitative endovascular balloon occlusion of the aorta in an urban Level I trauma center

Jamie B Hadley et al. J Trauma Acute Care Surg. .

Abstract

Background: The rationale for resuscitative endovascular balloon occlusion of the aorta (REBOA) is to control life-threatening subdiaphragmatic bleeding and facilitate resuscitation; however, incorporating this into the resuscitative practices of a trauma service remains challenging. The objective of this study is to describe the process of successful implementation of REBOA use in an academic urban Level I trauma center. All REBOA procedures from April 2014 through December 2019 were evaluated; REBOA was implemented after surgical faculty attended a required and internally developed Advanced Endovascular Strategies for Trauma Surgeons course. Success was defined by sustained early adoption rates.

Methods: An institutional protocol was published, and a REBOA supply cart was placed in the emergency department with posters attached to depict technical and procedural details. A focused professional practice evaluation was utilized for the first three REBOA procedures performed by each faculty member, leading to internal privileging.

Results: Resuscitative endovascular balloon occlusion of the aorta was performed in 97 patients by nine trauma surgeons, which is 1% of the total trauma admissions during this time. Each surgeon performed a median of 12 REBOAs (interquartile range, 5-14). Blunt (77/97, 81%) or penetrating abdominopelvic injuries (15/97, 15%) comprised the main injury mechanisms; 4% were placed for other reasons (4/97), including ruptured abdominal aortic aneurysms (n = 3) and preoperatively for a surgical oncologic resection (n = 1). Overall survival was 65% (63/97) with a steady early adoption trend that resulted in participation in a Department of Defense multicenter trial.

Conclusion: Strategies for how departments adopt new procedures require clinical guidelines, a training program focused on competence, and a hospital education and privileging process for those acquiring new skills.

Level of evidence: Therapeutic, level V.

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Figures

Figure 1:
Figure 1:
Comparison of REBOA insertion, ED Thoracotomy, and Emergent Laparotomy numbers over time
Figure 2:
Figure 2:
Denver Health Algorithm for torso hemorrhage control. EDT, emergency department resuscitative thoracotomy(4).
Figure 3:
Figure 3:
Revised Denver Health Algorithm for the management of hemodynamically unstable patients with mechanically unstable pelvic fractures. ATLS, advanced trauma life support.
Figure 4:
Figure 4:
4A: REBOA Cart located in the DH Emergency Room 4B: Top of REBOA cart with procedural pictures, algorithms, and cart contents. Attending physician personal contact number has been de-identified with white bar. 4C: Example of REBOA Cart drawer content of supplies for procedure including sterile gloves of varying sizes, suture, scalpel, manual blood pressure cuff. 4D: Example of REBOA cart drawer content of supplies containing the Prytime ER-REBOA™.
See this image and copyright information in PMC

References

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