Endovascular Balloon Occlusion of the Aorta Flashcards
What is REBOA , indications and algorithms are based on ?
-Proximal aortic control using REBOA
-the presence or absence of signs of life on admission
Indications for REBOA
-Blunt trauma patients arriving with loss of vitals, with organized rhythm detected on an EKG or FAST
-Penetrating trauma who underwent CPR for less than 15 minutes with a potential source of bleeding in the abdomen/ pelvis/ extremity and absent devastating head injury
-In hemodynamically unstable patients with pelvic fractures and negative FAST/ DPA who have no evidence of significant thoracic bleeding or an aortic injury
Contraindications to REBOA
-traumatic aortic injury
-hemorrhage proximal to zones of occlusion including areas of the neck, axilla, and superior mediastinum
REBOA is hazardous in traumatic brain injury, blunt cardiac, penetrating neck, or chest trauma
Relative Contraindications
-elderly age (age > 70 years)
-PEA arrest longer than 10 minutes
-presence of terminal illness
-profound comorbidities.
complications from femoral arterial cannulation
Thrombosis and distal embolization leading to limb ischemia
This risk increases with larger catheters and with the cannulation of smaller arteries.
After Placing REBOA Check What ?
Assessment of distal limb perfusion after REBOA placement is important to identify and mitigate ischemic complications.
How to Avoid Ischemia in Cannulation
Cannulation of the common femoral artery (CFA) rather than the SFA is a key step in avoiding ischemic complications
Zones of REBOA
-Zone 1 extends from the left subclavian artery to the celiac artery.
-Zone 2 is between the celiac artery and the lowest renal artery
-Zone 3 extends from the lowest renal artery to the aortic bifurcation.
The balloon should never be inflated in zone 2 to avoid the occlusion of visceral vessels
The goal is to inflate the REBOA catheter in zone 1 or zone 3
Zone 1 and 3 Corresponds to ?
zone 1 and zone 3 corresponds to the xiphoid process and the umbilicus, respectively
How to check REBOA Position
imaging (x-ray or fluoroscopy) to ensure proper positioning of the catheter before balloon inflation
When to Stop inflating the Balloon
The balloon is slowly inflated until the contralateral femoral pulse is lost
Safe duration of complete aortic occlusion
is within 15 and 30 minutes for a balloon inflated in zones 1 and 3
Rate Limiting Step for REBOA
obtaining safe and accurate CFA access
Complications of REBOA
-femoral access complications include arterial disruption, dissection, pseudoaneurysms, hematoma, thromboembolism, extremity ischemia
-Aortoiliac injuries include intimal tear, dissection, thrombosis, and rupture, which may be fatal or cause limb loss
-Thrombus formation
It is crucial to check for Doppler signals after balloon deflation
angiography should be performed before sheath removal to evaluate for distal thromboembolism
