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2016 ; 11
(ä): 20
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Resuscitative endovascular balloon occlusion of the aorta for uncontrollable
nonvariceal upper gastrointestinal bleeding
#MMPMID27213011
Sano H
; Tsurukiri J
; Hoshiai A
; Oomura T
; Tanaka Y
; Ohta S
World J Emerg Surg
2016[]; 11
(ä): 20
PMID27213011
show ga
BACKGROUND: Although resuscitative endovascular balloon occlusion of the aorta
(REBOA) in various clinical settings was found to successfully elevate central
blood pressure in hemorrhagic shock, this intervention is associated with high
mortality and may represent a last-ditch option for trauma patients. We conducted
a retrospective study of patients with nonvariceal upper gastrointestinal
bleeding (UGIB) who underwent REBOA to identify the effectiveness of REBOA and
reviewed published literatures. METHODS: REBOA were performed by trained acute
care physicians in the emergency room and intensive care unit. The deployment of
balloon catheters was positioned using ultrasonography guidance. Collected data
included clinical characteristics, hemorrhagic severity, blood cultures,
metabolic values, blood transfusions, REBOA-related complications and mortality.
A literature search using PUBMED to include "aortic occlusion" and
"gastrointestinal bleeding" was conducted. RESULTS: REBOA was attempted in eight
patients among 140 patients with UGIB and median age was 66 years. Systolic blood
pressure significantly increased after REBOA (66?±?20 vs. 117?±?45 mmHg,
p?0.01) and the total occlusion time of REBOA was 80?±?48 min. Strong positive
correlations were found between total occlusion time of REBOA and lactate
concentration (Spearman's r=0.77), clinical Rockwall score (Spearman's r=0.80),
and age (Spearman's r=0.88), respectively. CONCLUSION: REBOA can be performed
with a high degree of technical success and is effective at improving hemodynamic
in patients with UGIB. Correlations between total occlusion time and high lactate
levels, clinical Rockall score, and age may be important for successful use of
REBOA.