T. W. Wolff1,3, E. A. Naber1, M. L. Moorman1,2, M. C. Spalding1,2 1OhioHealth Grant Medical Center,Division Of Trauma And Acute Care Surgery,Columbus, OHIO, USA 2Ohio University Heritage College of Osteopathic Medicine,Athens, OHIO, USA 3OhioHealth Doctors Hospital,Department Of Surgery,Columbus, OHIO, USA
Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an emerging tool for trauma surgeons that serves as an alternative to open aortic occlusion in the acute resuscitation of patients in shock. Although placement is a team effort, program implementation is often surgeon-centric. We report our preparation and initial experience of a team-based REBOA program at an urban Level 1 trauma center in hopes to provide comparisons for similar centers initiating such programs.
Methods: Two trauma surgeons attended the Basic Endovascular Skills in Trauma course and subsequently trained the remaining trauma surgeons, residents, advanced practice providers, nurses, emergency physicians, pharmacists, and medics. A nurse educator liaised with the emergency department (ED), operating room (OR), and intensive care unit (ICU) nursing staff. Training involved didactics, high-fidelity simulation, and structured debriefing in all three settings.
Results: Six trauma surgeons placed 27 REBOA catheters (mean ISS-36, GCS-6, HR-82, SBP-52) for penetrating (5, 19%) and blunt mechanisms (22, 82%). Patient physiology, indication, common femoral artery (CFA) access, and outcome differed significantly between months 1-9 and 10-18 (see Figure). REBOA was performed in the ED (22, 81.5%), ICU (1, 3.7%), OR (3, 11.1%), and interventional radiology (1, 3.7%). In-hospital mortality (55.6%) was significantly different between the first and second 9-month periods (75% vs. 40%, p<0.05). Complications consisted of inability to obtain arterial access in four cases and a CFA pseudoaneurysm that resolved with manual pressure.
Conclusion: We successfully implemented a REBOA program with little external assistance and placed 27 catheters in 18 months with no complications requiring intervention. During the 18-month initiation period, the patient selection differed significantly over time, more percutaneous access was acheieved, and survival was significantly different. This can assist newly established REBOA programs in predicting early outcomes, patient selection, and likely complications.
