TIP Search

CLOSE


Trauma Image and Procedure > Volume 4(1); 2019 > Article
Gong and Jung: Inappropriate Resuscitative endovascular balloon occlusion of the aorta (REBOA) Catheter Placement in Patient With Unexpected Left Common Iliac Artery Rupture

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is effective method increasingly used in cases of traumatic noncompressible torso hemorrhage. However, it is performed in an emergency situation, and the source of hemorrhage cannot be verified during implementation, which may make it difficult to place the catheter accurately.
In the case reported here, catheter placement was inappropriate.

CASE

A 70-year-old man came to our facility after a car accident. The vital signs were unstable; blood pressure could not be recorded at the time of arrival. Immediately after arrival, cardiac arrest occurred twice, and resuscitation was successful. In the emergency room, he underwent brief sonographic examination, and a massive fluid collection was observed in the splenorenal recess. Resuscitative endovascular balloon occlusion of the aorta (REBOA) was also performed with blind puncture technique during the resuscitation. The balloon was inflated with 25 mL of normal saline, but there was no sense of resistance, which is considered unusual. Placement of the catheter tip was checked with bedside ultrasonography but was not clearly confirmed because of the massive fluid collection. In general, catheter tip placement is confirmed with radiography, fluoroscopy, or ultrasonography [1], but the serious emergency situation precluded these assessments. The patient’s blood pressure recovered to 80/50 mm Hg, and he was moved to the operating room immediately.
During the operation, vascular rupture from aortic bifurcation to the left common iliac artery was confirmed (Fig. 1). The REBOA catheter was found to be misplaced: It had been inserted correctly via the femoral artery, but it exited through the ruptured pore of the iliac artery (Fig. 2). We inserted the catheter back into the aorta urgently and then compressed the injured site to control bleeding; however, cardiac arrest continued. The abdomen was closed, the patient was moved to the intensive care unit, and then he was pronounced dead.

DISCUSSION

Noncompressible torso hemorrhage (NCTH) is associated with a high mortality rate (45%) and is the leading cause of death from trauma [2]. Controlling hemorrhage is therefore a key part of management. REBOA is a technique in which an inflatable balloon is temporarily inserted in aorta to increase cardiac afterload until definitive management can be performed [3]. For this reason, it has been increasingly used in trauma and prehospital care [4].
However, various complications have also been reported, such as vessel injury, distal ischemia, ischemia-reperfusion injury, and cardiovascular complications [5]. Furthermore, extreme caution is required in treating unstable pelvic fractures or potential iliofemoral vascular injuries [6].
I therefore suggest that REBOA be performed by experienced, professional medical personnel and that appropriate patient selection be considered as well.

Notes

Conflict of Interest Statement

None of authors have a conflict of interest

Fig. 1.
Ruptured left common iliac artery.
tip-4-1-10f1.jpg
Fig. 2.
Catheter used in resuscitative endovascular balloon occlusion of the aorta (REBOA) that escaped from the ruptured pore of the iliac artery.
tip-4-1-10f2.jpg

REFERENCES

1. Daley J, Morrison JJ, Sather J, Hile L. The role of resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct to ACLS in non-traumatic cardiac arrest. Am J Emerg Med. 2017;35(5):731-6.
crossref pmid
2. Kisat M, Morrison JJ, Hashmi ZG, Efron DT, Rasmussen TE, Haider AH. Epidemiology and outcomes of non- compressible torso hemorrhage. J Surg Res. 2013;184(1):414-21.
crossref pmid
3. Sadeghi M, Nilsson KF, Larzon T, Pirouzram A, Toivola A, Skoog P, et al. The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry. Eur J Trauma Emerg Surg. 2018;44(4):491-501.
crossref pmid pmc pdf
4. Zhang J, Watson JD, Drucker C, Kalsi R, Crawford RS, Toursavadkohi SA, et al. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Not Yet Applicable for Widespread Out-of-Hospital Use: A Case of Nonsurvivable Complication from Prolonged REBOA Inflation. Ann Vasc Surg. 2019;56:354 e5- e9.
crossref
5. Ribeiro Junior MAF, Feng CYD, Nguyen ATM, Rodrigues VC, Bechara GEK, de-Moura RR, et al. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World J Emerg Surg. 2018;13:20.
crossref pmid pmc pdf
6. Ozkurtul O, Staab H, Osterhoff G, Ondruschka B, Hoch A, Josten C, et al. Technical limitations of REBOA in a patient with exsanguinating pelvic crush trauma: a case report. Patient Saf Surg. 2019;13:25.
crossref pmid pmc pdf


ABOUT
ARTICLE CATEGORY
Article Category

Browse all articles >

BROWSE ARTICLES
FOR AUTHORS AND REVIEWERS
Editorial Office
Korean Association for Research, Procedures and Education on Trauma
#1618, 18, Mapo-daero 4da-gil, Mapo-gu, Seoul 04177, Korea
Tel: +82-2-3280-9013    E-mail: karpet@karpet.or.kr

Copyright © 2019 by Korean Association for Research Procedures and Education on Trauma. All rights reserved.

Developed in M2community

Close layer
prev next