Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Temporization of Hemorrhage in Pediatric Trauma Patients
*Alexis D Smith1, Phil Wasicek1, William Teeter1, Jessica A. Hudson2, Laura J. Moore3, Megan Brenner1
1R. Adams Cowley Shock Trauma Center, Baltimore, MD;2Texas Trauma Institute, University of Texas at Houston, Houson, TX;3Texas Trauma Institute, University of Texas at Houston, Houston, TX
Background (issue):Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative technique for traumatic hemorrhagic shock control in the adult population. The feasibility of REBOA in adolescent trauma patients in the US has not been described.
Methods: Patients 18 years of age or less who received REBOA for aortic occlusion (AO) from August 2013 to February 2017 at 2 urban tertiary care centers were included.
Findings: 7 adolescent trauma patients received REBOA by acute care surgeons for both blunt (n=4) and penetrating mechanisms (n=3); mean age was 17+1.5 years, mean admission lactate 13.0+4.85mmol/L, and mean Hgb 10.7+2.7g/dL. Cannulation of the common femoral artery (CFA) was performed via open cut down in 71.4% and percutaneous in 28.6%. 3 patients received REBOA through a 12Fr sheath and 4 through a 7Fr sheath. AO occurred mostly at the distal thoracic aorta (Zone I) (85.7%), and also in the distal abdominal aorta (Zone III) (14.3%). 57% of patients were in arrest with ongoing CPR at the time of REBOA, and overall in-hospital mortality was 57%; all of these patients were in arrest at the time of REBOA with ongoing CPR, had return of spontaneous circulation (ROSC), and survived to the operating room. No complications from REBOA were identified.
Conclusions (implications for practice):REBOA appears to be safe for use in adolescents despite their smaller caliber vessels, even with use of a 12Fr sheath. REBOA results in improved physiology and may bridge adolescent patients to the operating room, even those in arrest with ongoing CPR.
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