Maternal hemodynamics during aortic occlusion with REBOA in patients with placenta accreta spectrum disorder

The effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) in controlling pelvic bleeding has been reported with increasing frequency during surgical management of placenta accreta spectrum (PAS). The deployment of REBOA may lead to significant variations in vital signs requiring special care by anesthesiology during surgery. These modifications of blood pressure by REBOA in PAS patients have not been accurately documented. We report the changes in blood pressure that occur when the aorta is occluded and then released in patients with PAS.

This prospective, observational study includes 10 patients with preoperative PAS suspicion who underwent prophylactic REBOA device insertion between April 2018 and October 2019. REBOA procedural-related data and blood pressure fluctuations under invasive monitoring before and after inflation and deflation were recorded in the operating room.

After prophylactic REBOA deployment in zone 3 of the aorta in PAS patients, we observed a transitory increase in blood pressure (median increase of 22.5 mmHg in SBP and 9.5 mmHg in DBP), which reached severe hypertension (SBP >160 mmHg) in 50% of patients. All patients presented a decrease in blood pressure after the removal of the aortic occlusion (median decrease of 23 mmHg in SBP and 10.5 mmHg in DBP), and 50% (five patients) required the administration of vasopressor drugs.

Immediately after aortic occlusion is applied in zone 3 in PAS patients and after the occlusion is removed, significant hemodynamic changes occur, which often lead to therapeutic interventions.