REBOA Flashcards
What is a leading cause of preventable trauma deaths?
Non-compressible haemorrhage
What injuries are associated with rapid exsanguination and mortality rates nearing 50%?
Pelvic, abdominal, thoracic and junctional vascular injuries
What is the recommended approach to the management of exsanguinating patients in extremis?
A resuscitative thoracotomy and clamping the descending aorta which is associated with poor outcomes
What is REBOA?
Resuscitative endovascular ballon occlusion of the aorta
What does the REBOA procedure involve?
The placement of an endovascular balloon in the aorta to gain proximal control of exsanguinating haemorrhage
What can be used as an alternative to performing a resuscitative thoracotomy in traumatic arrest or as an adjunct for temporising intra-thoracic, abdominal, pelvic or junctional haemorrhage?
REBOA
Where does zone 1 for REBOA extend from?
Origin of the left subclavian artery to the coeliac artery
Where does zone 2 for REBOA extend from?
Coeliac artery to the mouth at caudal renal artery
Where does zone 3 for REBOA extend distally from?
The most caudal renal artery to the aortic bifurcation
What are the 2 areas of the aorta that are of interest in the context of catastrophic control?
The Supra-coeliac aorta (immediately above the coeliac trunk and diaphragm) and the terminal aorta (below the renal and mesenteric arteries)
In young adult males, zone 1,2 and 3 are approximately how long in length?
Zone 1 - 20 cm
Zone 2 - 3 cm
Zone 3 - 10cm
In young adult males what is the diameter of the thoracic aorta and distal aorta?
Thoracic aorta - 20mm
Distal aorta - 15mm
What is the average distance from puncture site to the terminal aorta and supra-coeliac aorta for REBOA?
To terminal aorta - 30 cm
To supra-coeliac aorta - 45 cm
As distances and diameters are variable in every patient, when inserting the REDOA catheter what is essential?
Measurement of surface anatomy and careful feel for the balloon abutting the aortic wall
What is the external landmark for the zone 1 ‘landing zone’?
Mid sternum
What is the external landmark for the zone 3 ‘landing zone’?
Immediately cranial to the umbilicus
What is the indications for a patient needing REBOA?
Adult trauma patient (over 16 years old) with blunt or penetrating injuries and suspected exsanguinating sub diaphragmatic haemorrhage indicated by:
- mechanism compatible with causing injuries resulting in exsanguinating haemorrhage
- identifiable injuries
- appropriate timescale
- hypotension/unrecordable BP
- pale, clammy
- absence of peripheral venous filling
- air hunger
- low/falling end tidal CO2
Is recent hypovalaemic cardiac arrest a contra indication to REBOA?
No, but common femoral artery cannulation is likely to be challenging
What is the priority for all patients who have undergone REBOA?
To expedite the patients transfer to theatre and the patient will require rapid surgical intervention. ED should be seen as a pit stop
What essential investigations should be done for REBOA patients?
Blood gas
Essential pharmacotherapy e.g. TXA
FAST scan
Chest and pelvic X-ray
Abdo X-ray to check balloon locations
An attempt a P-REBOA
If a patients has had a REBOA where should the balloon be seen in zone 1 or zone 3?
Zone 1 - just above the diaphragm
Zone 3 - overlying the L2-L4 vertebrae
To prevent the need to re-transduce the IABP lines for a patient who has had a REBOA pre-hospital what should be done in resus?
Patient should remain on the HEMs monitor
What should happen to REBOA patients who remain haemodynamically unstable and any patient with hemoperitoneum on FAST scan?
Transfer to theatre without delay
If a REBOA patient is responding well to blood transfusion what could be considered?
Attempt P-REBOA with a view to undertaking CT and subsequent angioembolisation in the IR suite
