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Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan
  1. Yosuke Matsumura1,
  2. Junichi Matsumoto2,
  3. Hiroshi Kondo3,
  4. Koji Idoguchi4,
  5. Tokiya Ishida5,
  6. Yuri Kon6,
  7. Keisuke Tomita7,
  8. Kenichiro Ishida8,
  9. Tomoya Hirose9,
  10. Kensuke Umakoshi10,
  11. Tomohiro Funabiki11
  12. DIRECT-IABO Investigators
  1. 1R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, USA
  2. 2Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine, Kawasaki, Japan
  3. 3Department of Radiology, Teikyo University School of Medicine, Itabashi-ku, Japan
  4. 4Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano, Japan
  5. 5Emergency and Critical Care Center, Ohta Nishinouchi Hospital, Koriyama, Japan
  6. 6Emergency and Critical Care Center, Hachinohe City Hospital, Hachinohe, Japan
  7. 7Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
  8. 8Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, National Hospital Organization, Osaka, Japan
  9. 9Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
  10. 10Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Toon, Japan
  11. 11Emergency and Critical Care Center, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
  1. Correspondence to Dr Yosuke Matsumura, R Adams Cowley Shock Trauma Center, University of Maryland, 22 S Greene St, Baltimore, MD 21201, USA; yousuke.jpn4035{at}gmail.com

Abstract

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) performed by emergency physicians has been gaining acceptance as a less invasive technique than resuscitative thoracotomy.

Objective To evaluate access-related complications and duration of occlusions during REBOA.

Methods Patients with haemorrhagic shock requiring REBOA, from 18 hospitals in Japan, included in the DIRECT-IABO Registry were studied. REBOA-related characteristics were compared between non-survivors and survivors at 24 hours. 24-Hour survivors were categorised into groups with small (≤8 Fr), large (≥9 Fr) or unusual sheaths (oversized or multiple) to assess the relationship between the sheath size and complications. Haemodynamic response, occlusion duration and outcomes were compared between groups with partial and complete REBOA.

Results Between August 2011 and December 2015, 142 adults undergoing REBOA were analysed. REBOA procedures were predominantly (94%) performed by emergency medicine (EM) physicians. The median duration of the small sheath (n=53) was 19 hours compared with 7.5 hours for the larger sheaths (p=0.025). Smaller sheaths were more likely to be removed using external manual compression (96% vs 45%, p<0.001). One case of a common femoral artery thrombus (large group) and two cases of amputation (unusual group) were identified. Partial REBOA was carried out in more cases (n=78) and resulted in a better haemodynamic response than complete REBOA (improvement in haemodynamics, 92% vs 70%, p=0.004; achievement of stability, 78% vs 51%, p=0.007) and allowed longer occlusion duration (median 58 vs 33 min, p=0.041). No statistically significant difference in 24-hour or 30-day survival was found between partial and complete REBOA.

Conclusion In Japan, EM physicians undertake the majority of REBOA procedures. Smaller sheaths appear to have fewer complications despite relatively prolonged placement and require external compression on removal. Although REBOA is a rarely performed procedure, partial REBOA, which may extend the occlusion duration without a reduction in survival, is used more commonly in Japan.

  • resuscitative endovascular balloon occlusion of the aorta
  • REBOA
  • hemorrhagic shock
  • complication
  • partial occlusion
  • arterial access
  • sheath

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Footnotes

  • Contributors YM contributed to study conception and design, analysis and interpretation of data, statistical analysis, drafting of the manuscript. JM, HK, KId and TF contributed to critical revision of the manuscript for important intellectual content, and provided intellectual input to the research and manuscript. TI, YK, KT, KIs, TH and KU contributed to acquisition of data, and provided intellectual input to the research and manuscript. All authors read and approved the manuscript.

  • Competing interests YM is a clinical advisory member of Tokai Medical Products.

  • Ethics approval Japanese Association of Surgery of Trauma ethics committee, Chiba University Graduate School of Medicine and institutional review board in all participating hospitals.

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

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