Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Non-compressible Torso Hemorrhage

Authors

  • Derek J Roberts
  • Bryan A Cotton
  • Juan Duchesne
  • Paula Ferrada
  • Tal M Horer
  • David Kauvar
  • Mansoor Khan
  • Andrew W Kirkpatrick
  • Carlos Ordoñez
  • Bruno Perreira
  • Artai Priouzram
  • Megan L Brenner

DOI:

https://doi.org/10.26676/jevtm.v4i2.136

Keywords:

Emergency Department Thoracotomy, Noncompressible Torso Hemorrhage, Resuscitative Endovascular Balloon Occlusion of the Aorta, Wounds and Injuries

Abstract

Non-compressible torso hemorrhage (NCTH) (i.e. bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this article, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude by providing recommendations as to when each of these methods may be best, when indicated, to manage injured patients with NCTH.

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Published

2020-10-29

How to Cite

Roberts, D. J., Cotton, B. A., Duchesne, J., Ferrada, P., Horer, T. M., Kauvar, D., … Brenner, M. L. (2020). Endovascular Versus Open: Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta or Thoracotomy for Management of Post-Injury Non-compressible Torso Hemorrhage . Journal of Endovascular Resuscitation and Trauma Management, 4(2), 109–119. https://doi.org/10.26676/jevtm.v4i2.136

Issue

Section

Narrative Review Articles

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