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Notfall + Rettungsmedizin
Erschienen in:

02.01.2018 | Leitthema

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)

Brauchen wir das wirklich?

verfasst von: M. Wortmann, K. Elias, S. Zerwes, D. Böckler, Prof. Dr. A. Hyhlik-Dürr

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 2/2019

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Zusammenfassung

Hintergrund

Nichtkomprimierbare Blutungen des Körperstamms stellen eine der Haupttodesursachen traumatisierter Patienten, sowohl im militärischen als auch im zivilen Bereich, dar.

Ziel

Die REBOA-Technik (REBOA Resuscitative Endovascular Balloon Occlusion of the Aorta), mögliche Einsatzgebiete, potenzielle Komplikationen und die Frage nach der Relevanz im Alltag des Notfallmediziners sollen erläutert werden.

Material und Methode

Beschreibung bisheriger Einsatzgebiete von REBOA, Auswertung der aktuellen Studienlage, Diskussion der praktischen Anwendung.

Ergebnisse

Im Rahmen der „Damage Control“ wird ein über die Leistenarterien eingebrachter Ballon proximal der vermuteten Blutungsquelle in der Aorta platziert, um damit ein Verbluten des Patienten zu verhindern und eine weitere Versorgung durchführen zu können. Die aktuelle Studienlage zeigt, dass REBOA in den meisten Fällen zu einer Verbesserung des systolischen Blutdrucks sowie des mittleren arteriellen Blutdrucks und zu einer Reduktion der Herzfrequenz führt. Eine Reduktion der blutungsassoziierten Mortalität konnte bislang jedoch noch nicht sicher gezeigt werden.

Schlussfolgerungen

Aufgrund der möglichen Komplikationen während und nach der REBOA-Prozedur ist eine gefäßchirurgische Expertise unabdingbar. Zudem sind wegen der geringen Fallzahlen sowohl anfängliche Schulungen als auch regelmäßige Übungen notwendig. Dennoch stellt REBOA eine potenziell lebensrettende Sofortmaßnahme dar, die als solche im Portfolio von Traumazentren vorgehalten werden sollte.
Vorheriger Artikel Invasive Notfalltechniken – INTECH Advanced
Nächster Artikel Notfallkoniotomie – chirurgisch oder doch Punktion?
Literatur
1.
Eastridge BJ, Mabry RL, Seguin P et al (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 73:S431–S437CrossRef
2.
Stannard A, Morrison JJ, Scott DJ et al (2013) The epidemiology of noncompressible torso hemorrhage in the wars in Iraq and Afghanistan. J Trauma Acute Care Surg 74:830–834CrossRef
3.
Kleber C, Giesecke MT, Tsokos M et al (2013) Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg 37:1154–1161CrossRef
4.
Perkins ZB, Lendrum RA, Brohi K (2016) Resuscitative endovascular balloon occlusion of the aorta: promise, practice, and progress? Curr Opin Crit Care 22(6):563–571PubMed
5.
Daley J, Morrison JJ, Sather J et al (2017) The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest. Am J Emerg Med 35:731–736CrossRef
6.
Ergle K, Parto P, Krim SR (2016) Percutaneous ventricular assist devices: a novel approach in the management of patients with acute cardiogenic shock. Ochsner J 16:243–249PubMedPubMedCentral
7.
Hughes CW (1954) Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery 36:65–68PubMed
8.
Phillips SJ, Gordon DF, Iannone L et al (1980) Clinical trial with a percutaneously inserted intra-aortic balloon pump: a wider spectrum of patient application. Thorac Cardiovasc Surg 28:197–199CrossRef
9.
Volodos NL, Karpovich IP, Troyan VI et al (1991) Clinical experience of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for aorta reconstruction. Vasa Suppl 33:93–95PubMed
10.
Parodi JC, Palmaz JC, Barone HD (1991) Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg 5:491–499CrossRef
11.
Starnes BW, Quiroga E, Hutter C et al (2010) Management of ruptured abdominal aortic aneurysm in the endovascular era. J Vasc Surg 51:9–17 (discussion 17–18)CrossRef
12.
Arthurs ZM, Sohn VY, Starnes BW (2007) Ruptured abdominal aortic aneurysms: remote aortic occlusion for the general surgeon. Surg Clin North Am 87:1035–1045CrossRef
13.
Johnson MA, Neff LP, Williams TK et al (2016) Partial resuscitative balloon occlusion of the aorta (P-REBOA): clinical technique and rationale. J Trauma Acute Care Surg 81:S133–S137CrossRef
14.
Kisat M, Morrison JJ, Hashmi ZG et al (2013) Epidemiology and outcomes of non-compressible torso hemorrhage. J Surg Res 184:414–421CrossRef
15.
Rabinovici R, Bugaev N (2014) Resuscitative thoracotomy: an update. Scand J Surg 103:112–119CrossRef
16.
Reuben BC, Whitten MG, Sarfati M et al (2007) Increasing use of endovascular therapy in acute arterial injuries: analysis of the national trauma data bank. J Vasc Surg 46:1222–1226CrossRef
17.
Branco BC, Dubose JJ, Zhan LX et al (2014) Trends and outcomes of endovascular therapy in the management of civilian vascular injuries. J Vasc Surg 60:1297–1307.e1CrossRef
18.
Scalea TM, Sclafani S (2001) Interventional techniques in vascular trauma. Surg Clin North Am 81:1281–1297CrossRef
19.
Assar AN, Zarins CK (2009) Endovascular proximal control of ruptured abdominal aortic aneurysms: the internal aortic clamp. J Cardiovasc Surg (Torino) 50:381–385
20.
21.
Morrison JJ, Ross JD, Rasmussen TE et al (2014) Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties. Shock 41:388–393CrossRef
22.
System JTT (2014) Resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock. JAMA Surg 152(11):1072
23.
Brenner M, Hoehn M, Pasley J et al (2014) Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg 77:286–291CrossRef
24.
Teeter W, Romagnoli A, Glaser J et al (2017) Resuscitative endovascular balloon occlusion of the aorta: pushing care forward. J Spec Oper Med 17:17–21PubMed
25.
Morrison JJ, Percival TJ, Markov NP et al (2012) Aortic balloon occlusion is effective in controlling pelvic hemorrhage. J Surg Res 177:341–347CrossRef
26.
White JM, Cannon JW, Stannard A et al (2011) Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery 150:400–409CrossRef
27.
Dunn EL, Moore EE, Moore JB (1982) Hemodynamic effects of aortic occlusion during hemorrhagic shock. Ann Emerg Med 11:238–241CrossRef
28.
Spence PA, Lust RM, Chitwood WR Jr. et al (1990) Transfemoral balloon aortic occlusion during open cardiopulmonary resuscitation improves myocardial and cerebral blood flow. J Surg Res 49:217–221CrossRef
29.
Low RB, Longmore W, Rubinstein R et al (1986) Preliminary report on the use of the Percluder occluding aortic balloon in human beings. Ann Emerg Med 15:1466–1469CrossRef
30.
Brenner ML, Moore LJ, Dubose JJ et al (2013) A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg 75:506–511CrossRef
31.
Moore LJ, Brenner M, Kozar RA et al (2015) Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg 79:523–530 (discussion 530–522)CrossRef
32.
Norii T, Crandall C, Terasaka Y (2015) Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg 78:721–728CrossRef
33.
Saito N, Matsumoto H, Yagi T et al (2015) Evaluation of the safety and feasibility of resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg 78:897–903 (discussion 904)CrossRef
34.
Abe T, Uchida M, Nagata I et al (2016) Resuscitative endovascular balloon occlusion of the aorta versus aortic cross clamping among patients with critical trauma: a nationwide cohort study in Japan. Crit Care 20:400CrossRef
35.
Dubose JJ, Scalea TM, Brenner M et al (2016) The AAST prospective aortic occlusion for resuscitation in trauma and acute care surgery (AORTA) registry: data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg 81:409–419CrossRef
36.
Moore LJ, Martin CD, Harvin JA et al (2016) Resuscitative endovascular balloon occlusion of the aorta for control of noncompressible truncal hemorrhage in the abdomen and pelvis. Am J Surg 212:1222–1230CrossRef
37.
Teeter WA, Matsumoto J, Idoguchi K et al (2016) Smaller introducer sheaths for REBOA may be associated with fewer complications. J Trauma Acute Care Surg 81:1039–1045CrossRef
38.
Morrison JJ, Galgon RE, Jansen JO et al (2016) A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg 80:324–334CrossRef
39.
Russo RM, Williams TK, Grayson JK et al (2016) Extending the golden hour: partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. J Trauma Acute Care Surg 80:372–378 (discussion 378–380)CrossRef
40.
Joseph B, Ibraheem K, Haider AA et al (2016) Identifying potential utility of resuscitative endovascular balloon occlusion of the aorta: an autopsy study. J Trauma Acute Care Surg 81:S128–S132CrossRef
41.
Stannard A, Eliason JL, Rasmussen TE (2011) Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma 71:1869–1872PubMed
42.
Malina M, Veith F, Ivancev K et al (2005) Balloon occlusion of the aorta during endovascular repair of ruptured abdominal aortic aneurysm. J Endovasc Ther 12:556–559CrossRef
43.
Malina M, Holst J (2014) Balloon control for ruptured AAAs: when and when not to use? J Cardiovasc Surg (Torino) 55:161–167
44.
Panici PB, Anceschi M, Borgia ML et al (2012) Intraoperative aorta balloon occlusion: fertility preservation in patients with placenta previa accreta/increta. J Matern Fetal Neonatal Med 25:2512–2516CrossRef
45.
Delamare L, Crognier L, Conil JM et al (2015) Treatment of intra-abdominal haemorrhagic shock by resuscitative endovascular balloon occlusion of the aorta (REBOA). Anaesth Crit Care Pain Med 34:53–55CrossRef
46.
Miura F, Takada T, Ochiai T et al (2006) Aortic occlusion balloon catheter technique is useful for uncontrollable massive intraabdominal bleeding after hepato-pancreato-biliary surgery. J Gastrointest Surg 10:519–522CrossRef
47.
Deakin CD, Barron DJ (1996) Haemodynamic effects of descending aortic occlusion during cardiopulmonary resuscitation. Resuscitation 33:49–52CrossRef
48.
Sadek S, Lockey DJ, Lendrum RA et al (2016) Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation 107:135–138CrossRef
49.
Okada Y, Narumiya H, Ishi W et al (2017) Anatomical landmarks for safely implementing resuscitative balloon occlusion of the aorta (REBOA) in zone 1 without fluoroscopy. Scand J Trauma Resusc Emerg Med 25:63CrossRef
50.
Morrison JJ, Stannard A, Midwinter MJ et al (2014) Prospective evaluation of the correlation between torso height and aortic anatomy in respect of a fluoroscopy free aortic balloon occlusion system. Surgery 155:1044–1051CrossRef
51.
Napolitano LM (2017) Resuscitative endovascular balloon occlusion of the aorta: indications, outcomes, and training. Crit Care Clin 33:55–70CrossRef
52.
Clarke JR, Trooskin SZ, Doshi PJ et al (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 52:420–425PubMed
53.
Sovik E, Stokkeland P, Storm BS et al (2012) The use of aortic occlusion balloon catheter without fluoroscopy for life-threatening post-partum haemorrhage. Acta Anaesthesiol Scand 56:388–393CrossRef
54.
Gupta BK, Khaneja SC, Flores L et al (1989) The role of intra-aortic balloon occlusion in penetrating abdominal trauma. J Trauma 29:861–865CrossRef
55.
Keller BA, Salcedo ES, Williams TK et al (2016) Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation. J Trauma Acute Care Surg 81:606–611CrossRef
56.
Sridhar S, Gumbert SD, Stephens C et al (2017) Resuscitative endovascular balloon occlusion of the aorta: principles, initial clinical experience, and considerations for the anesthesiologist. Anesth Analg 125(3):884–890CrossRef
Metadaten
Titel
REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta)
Brauchen wir das wirklich?
verfasst von
M. Wortmann
K. Elias
S. Zerwes
D. Böckler
Prof. Dr. A. Hyhlik-Dürr
Publikationsdatum
02.01.2018
Verlag
Springer Medizin
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 2/2019
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-017-0396-1

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