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Date of Award
Spring 2020
Degree Name
<-- Please Select One -->
Department
Physician Assistant; College of Health Sciences
First Advisor
Kaitlyn Gamber
Second Advisor
Shannon Diallo
Abstract
Introduction: Exsanguination due to hemorrhage is the leading cause of death in victims of abdomino-pelvic trauma and one that is heavily dependent on time and the techniques at the hands of the resuscitative team to help in stabilizing vitals and maintaining as much control of the damage as possible before transport to the operating room. REBOA is a balloon catheter that is placed into the common femoral artery to occlude the aorta proximal to site of injury. Implementation of this device at point-of-injury could stabilize the patient and effectively increase critical time allowed for transport to a site of definitive care by preventing pre-hospital cardiac arrest due to hypovolemia.
Methods: A thorough review of the literature was performed using ClinicalKey, PUBMED, Google Scholar, and ScienceDirect. Nine articles were selected utilizing exclusion criteria of publication date, type of injury, and patient demographics. The articles were evaluated and compared via study design, results, and weighted significance to the topic as a whole.
Results: The studies evaluated exhibited a general significance in the positive impacts and performance of REBOA. Five studies found REBOA to be comparable or significantly better than other aortic occlusion techniques when examined in terms of overall mortality and vital sign stabilization. Six studies that evaluated the impacts of the catheter on mortality all found REBOA to significantly decrease mortality. Five of six studies examining the tool’s endurance of therapeutic benefits were found to be significant in improving vital signs, systolic blood pressure, and hemodynamic stability. Only one study directly evaluates the use of the REBOA in the field on the general population. This study is found to provide significant results on the performance of REBOA but the study only included 21 patients.
Discussion: The REBOA was shown to have significant positive outcomes in patients in each study. However, there is a lack of data specific to REBOA’s use in pre-hospital situations. The studies pertaining to pre-hospital REBOA have low population sizes and therefore carry less statistical weight. However the downstream effects of REBOA placement have been shown to be statistically significant in studies holding heavy weight in terms of sample size.
Conclusion: Use of pre-hospital REBOA could greatly contribute to the time allowed for resuscitative teams to try to regain control of vitals. Ultimately, the pre-hospital and pre-operative interventions available affect the capacity of surgeons to work to control the hemorrhage and limit the extent of cardiac shock. REBOA is a crucial tool that should be further explored in order to improve mortality.
Recommended Citation
Toner, Natalie, "The use of prehospital REBOA in patients suffering from hemorrhage due to abdomino-pelvic trauma" (2020). Capstone Showcase. 41.
https://scholarworks.arcadia.edu/showcase/2020/pa/41
The use of prehospital REBOA in patients suffering from hemorrhage due to abdomino-pelvic trauma
Introduction: Exsanguination due to hemorrhage is the leading cause of death in victims of abdomino-pelvic trauma and one that is heavily dependent on time and the techniques at the hands of the resuscitative team to help in stabilizing vitals and maintaining as much control of the damage as possible before transport to the operating room. REBOA is a balloon catheter that is placed into the common femoral artery to occlude the aorta proximal to site of injury. Implementation of this device at point-of-injury could stabilize the patient and effectively increase critical time allowed for transport to a site of definitive care by preventing pre-hospital cardiac arrest due to hypovolemia.
Methods: A thorough review of the literature was performed using ClinicalKey, PUBMED, Google Scholar, and ScienceDirect. Nine articles were selected utilizing exclusion criteria of publication date, type of injury, and patient demographics. The articles were evaluated and compared via study design, results, and weighted significance to the topic as a whole.
Results: The studies evaluated exhibited a general significance in the positive impacts and performance of REBOA. Five studies found REBOA to be comparable or significantly better than other aortic occlusion techniques when examined in terms of overall mortality and vital sign stabilization. Six studies that evaluated the impacts of the catheter on mortality all found REBOA to significantly decrease mortality. Five of six studies examining the tool’s endurance of therapeutic benefits were found to be significant in improving vital signs, systolic blood pressure, and hemodynamic stability. Only one study directly evaluates the use of the REBOA in the field on the general population. This study is found to provide significant results on the performance of REBOA but the study only included 21 patients.
Discussion: The REBOA was shown to have significant positive outcomes in patients in each study. However, there is a lack of data specific to REBOA’s use in pre-hospital situations. The studies pertaining to pre-hospital REBOA have low population sizes and therefore carry less statistical weight. However the downstream effects of REBOA placement have been shown to be statistically significant in studies holding heavy weight in terms of sample size.
Conclusion: Use of pre-hospital REBOA could greatly contribute to the time allowed for resuscitative teams to try to regain control of vitals. Ultimately, the pre-hospital and pre-operative interventions available affect the capacity of surgeons to work to control the hemorrhage and limit the extent of cardiac shock. REBOA is a crucial tool that should be further explored in order to improve mortality.