ABSTRACT
Background: The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment.In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm. Methods: Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2). Results: Systolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2. Conclusions: ER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion.
Subject(s)
Balloon Occlusion/methods , Emergency Medical Services , Endovascular Procedures , Hemorrhage/therapy , Military Medicine , Shock, Hemorrhagic/therapy , War-Related Injuries/therapy , Adult , Aorta, Thoracic , Blood Pressure , Endovascular Procedures/methods , Female , Hemorrhage/diagnosis , Hemorrhage/physiopathology , Humans , Male , Middle Aged , Military Personnel , Resuscitation , Shock, Hemorrhagic/diagnosis , Shock, Hemorrhagic/physiopathology , Treatment Outcome , War-Related Injuries/diagnostic imaging , War-Related Injuries/physiopathologyABSTRACT
The implementation of preventive devices is always a difficult task to anticipate. It is also difficult to verify the adequacy of resources used to the needs. For this purpose, the Belgian Red Cross created the computer tool collecting administrative information, diagnostic codes, destination of the patient, triage, level of emergency as well as kinetics of admission to the preventive care station. Data analysis in the various types of events confirms the usefulness of prevention devices. Although it can be improved, the tool is reliable and permits a great extent the adaptative means to the needs.
