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Original research
Placement accuracy of resuscitative endovascular occlusion balloon into the target zone with external measurement
  1. Shokei Matsumoto1,2,
  2. Tomohiro Funabiki2,
  3. Taku Kazamaki2,
  4. Tomohiko Orita2,
  5. Kazuhiko Sekine3,
  6. Motoyasu Yamazaki2,
  7. Takashi Moriya1
  1. 1Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  2. 2Department of Trauma and Emergency Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
  3. 3Department of Emergency Medicine, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
  1. Correspondence to Dr Shokei Matsumoto, Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama 329-0498, Japan; m-shokei{at}feel.ocn.ne.jp

Abstract

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) should be safely placed at zone 1 or 3, depending on the location of the hemorrhage. Ideally, REBOA placement should be confirmed via fluoroscopy, but it is not commonly available for trauma bays. This study aimed to evaluate the accuracy of REBOA placement using the external measurement method in a Japanese trauma center.

Methods A retrospective review identified all trauma patients who underwent REBOA and were admitted to our trauma center from 2008 to 2018. Patient characteristics, REBOA placement accuracy, and complications according to target zones 1 and 3 were reviewed.

Results During the study period, 38 patients met our inclusion criteria. The in-hospital mortality rate was 57.9%. REBOA was mainly used for bleeding from the abdominal (44.7%) and pelvic (36.8%) regions. Of these, 30 patients (78.9%) underwent REBOA for target zone 1, and 8 patients (21.1%) underwent REBOA for target zone 3. The proportion of abdominal bleeding source in the target zone 1 group was greater than that in the target zone 3 group (56.7% vs. 0%). Overall, the proportion of REBOA placement was 76.3% in zone 1, 21.1% in zone 2, and 2.6% in zone 3. The total REBOA placement accuracy was 71.1%. At each target zone, the REBOA placement accuracy for target zone 3 was significantly lower than that for target zone 1 (12.5% vs. 86.7%, p<0.001). No significant associations between non-target zone placement and patient characteristics, complications, or mortality were found.

Conclusions The REBOA placement accuracy for target zone 3 was low, and zone 2 placement accounted for 21.1% of the total, but no complications and mortalities related to non-target zone placement occurred. Further external validation study is warranted.

Level of evidence Level IV.

  • trauma/ critical care
  • resuscitation for shock
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2020-000443

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    Footnotes

    • Presented at This study was accepted as a poster presentation at the 78th Annual Meeting of the American Association for the Surgery of Trauma (AAST) in Dallas, Texas, on September 18, 2019. However, this was not presented due to a private issue.

    • Contributors SM, TK, and TF participated in the study design. SM and TO participated in the analysis and interpretation of data. SM, TM, and KS participated in drafting the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This retrospective study was approved by our institutional review board.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. No data are available.