ED Laparotomy & REBOA

Source pic: Link, Licence

Source pic: Link, Licence

In this month's episode, we were once again joined by Professor Mark Fitzgerald, Director of The Alfred Trauma Service, & Dr Joseph Mathew, Emergency & Trauma Physician to discuss a recent case of ED laparotomy as well as a broader discussion on the utility of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).

(We had full consent from the patient to put the details of this case up)

The Case

A 45 year motorcyclist who was involved in a high energy, high speed motorbike accident - resulting in exsanguinating lower limb and pelvic trauma.

Trauma Series X-rays:

Podcast:

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Further Reading

Joseph J. DuBose, MD, Thomas M. Scalea, MD, Megan Brenner, MD, Dimitra Skiada, MD, Kenji Inaba, MD, Jeremy Cannon, MD, Laura Moore, MD, John Holcomb, MD, David Turay, MD, Cassra N. Arbabi, MD, Andrew Kirkpatrick, MD, James Xiao, MD, David Skarupa, MD, Nathaniel Poulin, MD, and the AAST AORTA Study Group, Davis, California. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016 Sep;81(3):409-19

Rachel M Russo, MD, Lucas P Neff, MD, Christopher M Lamb, FRCS, Jeremy W Cannon, MD, Joseph M Galante, MD, Nathan F Clement, MD, J Kevin Grayson, DVM, PhD, Timothy K Williams, MD.  Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock. J Am Coll Surg. 2016 Aug;223(2):359-68.

Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. 2016 Jul 1. pii: S0300-9572(16)30136-8. doi: 10.1016/j.resuscitation.2016.06.029. [Epub ahead of print]

Moore LJ, Brenner M, Kozar RA, Pasley J, Wade CE, Baraniuk MS, Scalea T, Holcomb JB.  Implementation of resuscitative endovascular balloon occlusion of the aorta as an alternative to resuscitative thoracotomy for noncompressible truncal hemorrhage. J Trauma Acute Care Surg. 2015 Oct;79(4):523-30; discussion 530-2.

Qasim Z, Brenner M, Menaker J, Scalea T.  Resuscitative endovascular balloon occlusion of the aorta. Resuscitation. 2015 Nov;96:275-9. doi: 10.1016/j.resuscitation.2015.09.003. Epub 2015 Sep 16.

LITFL REBOA - Based largely on the ACE Protocol developed at The Alfred by Robbie Lendrum & Colleagues

EMCrit Podcast 170 - The ER REBOA Catheter

EMCrit Podcast 121 - REBOA

EMCrit Podcast 133 - The First Pre-Hospital REBOA