REBOA: The Dark Side COL Matthew J. Martin, MD Madigan Army Medical - PowerPoint PPT Presentation

2016 Austin Trauma Critical Care Conference REBOA: The Dark Side COL Matthew J. Martin, MD Madigan Army Medical Center Taking the Winning Position

R esuscitative E ndovascular B alloon O cclusion of the A orta

REBOA is a GREAT idea

REBOA is a GREAT idea  Known pathology  No OTHER problems  Have some time  Vascular surgeon  Controlled access and placement

The “Unstable” Trauma Patient  Chaotic  Unclear extent of injuries  Unclear location of injuries  could be harmful w REBOA  Trauma/EM doc with less experience  Access much more difficult  Scoop and RUN! May have only one shot

Early Complications

More Vascular Complications?

Animal Studies  Anesthetized healthy animal  Controlled OR environment  Single injury – usually vascular  Direct vascular access  Perfect placement  NON survival

Norii T, et al. J Trauma and Acute Care Surg , 2015

 41 Studies  "Evidence base is weak"  "NO clear reduction in mortality"  Significant device-related morbidity reported

“REBOA would appear to be well suited to the geography of Scotland, which includes a spectrum of topography ranging from major urban lowland regions to rural Northern and island territories. Morrison JJ. The Surgeon . 2014

Direct to OR

Massive Ischemia-Reperfusion Injury

Massive Ischemia-Reperfusion Injury 30 minutes 30 minutes 60 minutes 60 minutes

The Clock is Ticking!

Adjunct for Nonoperative Management?

Key Points  REBOA is unproven and experimental  Potential benefit in VERY FEW scenarios  Major risks of complications from placement  Major risks of complications from aortic occlusion  NOT ready for widespread adoption