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Time to aortic occlusion: It's all about access.

Anna Romagnoli1, William Teeter, Jason Pasley

  • 1From the Division of Trauma/Critical Care (A.N.R., W.T., J.P., M.H., D.S., T.S., M.B.), RA Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland; Division of Anesthesiology (P.M.H.), University of Maryland School of Medicine, Baltimore, Maryland; and Division of Vascular Surgery (M.H., M.B.), University of Maryland School of Medicine, Baltimore, Maryland.

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Summary
This summary is machine-generated.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is faster than resuscitative thoracotomy with aortic cross-clamping (RTACC) once arterial access is obtained. Expedient common femoral artery (CFA) access is crucial for REBOA’s efficiency.

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Area of Science:

  • Emergency Medicine
  • Surgical Techniques
  • Trauma Care

Background:

  • Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a less invasive approach to proximal aortic occlusion compared to resuscitative thoracotomy with aortic cross-clamping (RTACC).
  • The primary determinant of REBOA's clinical utility is the time required to achieve aortic occlusion.

Purpose of the Study:

  • To compare the time to aortic occlusion between REBOA and RTACC.
  • To evaluate the impact of common femoral artery (CFA) cannulation time on REBOA procedure duration.

Main Methods:

  • A retrospective review of REBOA and RTACC procedures performed between February 2013 and January 2016.
  • Videographic analysis to determine time from skin incision to aortic cross-clamp (RTACC) and from guide-wire insertion to balloon inflation (REBOA).
  • Separate analysis of CFA cannulation times for REBOA.

Main Results:

  • REBOA procedures (n=21) took a median of 474 seconds from arterial access to Zone 1 balloon occlusion, compared to 317 seconds for RTACC (n=18) (p=0.01).
  • However, once CFA access was established, REBOA aortic occlusion time was significantly shorter at 245 seconds compared to RTACC (p=0.003).
  • Median CFA cannulation time was 247 seconds, with no significant difference between percutaneous and open methods.

Conclusions:

  • REBOA is faster than RTACC for aortic occlusion once common femoral artery (CFA) access is achieved.
  • Efficient CFA access is critical for optimizing REBOA procedure times.
  • REBOA presents a feasible alternative to thoracotomy for aortic occlusion, with potential for further time improvements with technological advancements.