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Challenges in trauma and acute care surgery
Potential benefit of early operative utilization of low profile, partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA) in major traumatic hemorrhage
  1. Anders J Davidson1,2,
  2. Rachel M Russo1,2,
  3. Joseph J DuBose1,2,3,
  4. Jon Roberts1,
  5. Gregory J Jurkovich1,
  6. Joseph M Galante1
  1. 1Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, California, USA
  2. 2Department of General Surgery, David Grant USAF Medical Center, Travis Air Force Base, California, USA
  3. 3Department of Vascular and Endovascular Surgery, David Grant USAF Medical Center, Travis Air Force Base, California, USA
  1. Correspondence to Dr Anders J Davidson, ajdavidson{at}ucdavis.edu

https://doi.org/10.1136/tsaco-2016-000028

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    A 28-year-old man with multiple gunshot wounds to the chest and upper extremities was transported by private vehicle to a community hospital with limited trauma capabilities. On arrival he developed pulseless electrical activity and cardiopulmonary resuscitation was initiated. He was intubated, transfused with 4 units of packed red blood cells, and resuscitated with 2 L of crystalloid prior to regaining spontaneous circulation. Left-sided tube thoracostomy immediately drained 1600 mL of bright red blood. He was transiently stable for a short transport to the nearest level 1 trauma center.

    On arrival the patient was normotensive with tachycardia. Chest X-ray demonstrated persistent left-sided hemothorax despite a well-positioned chest tube. Focused Assessment with Sonography for Trauma (FAST) examination was negative for pericardial fluid, but positive for intra-abdominal fluid. During the secondary examination the patient became hypotensive with systolic blood pressure (SBP) in the 70 s. A massive transfusion protocol was initiated, tranexamic acid was administered, and the patient was promptly transported to the operating room.

    The patient transiently responded to the massive transfusion. While instruments were being opened in the operating room, he again became hypotensive with SBP in the 50 s. The patient was acidotic (pH of 6.87, base excess −14.6), coagulopathic (international normalized ratio of 1.5) and …

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