Megan Brenner – REBOA

Dr. Megan Brenner is currently one of the leaders in the development of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).  As a trained trauma, critical care, and vascular surgeon Dr. Brenner is actively developing the integration of REBOA here at the Shock Trauma Center and the University of Maryland for both trauma and medical patients experiencing massive hemorrhage.  During this talk Dr. Brenner discusses her experience with REBOA, its indications, potential uses, and why she believes this is a critically important tool for all resuscitationists to learn.

Lecture Key Points

Indication:  Exsaguinating hemorrhage below the diaphragm (blunt/penetrating trauma, non-traumatic bleeding)
Problem:  Cross-clamping the Aorta does not usually end well
Solution:  Endovascular occlusion (REBOA) prevents a morbid surgery and buys time for definitive repair.  Needs to be performed by bedside providers!

  • We’re behind in the US!  Currently, REBOA can only be inserted by femoral cutdown since the FDA has only approved a vascular catheter that can fit through a 12 Fr arterial sheath.  This size sheath requires a surgical vascular repair.

For the trauma patient, you only need 3 diagnostic tests prior to considering REBOA

  1. CXR
  2. Pelvic XR
  3. FAST exam

Current algorithm here at STC

Reboa algorithm

 

Balloon Landing Zones

Reboa zones

Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011;71(6):1869-72.

 

The BEST Course: If you are a surgeon interested in coming to Baltimore and attending the Basic Endovascular Skills for Trauma course at the Shock Trauma Center, email BEST@umm.edu for dates and information.

 

Suggested Readings & Additional References

  1. White JM, Cannon JW, Stannard A, Markov NP, Spencer JR, Rasmussen TE. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock. Surgery. 2011;150(3):400-9.
  2. Brenner ML, Moore LJ, Dubose JJ, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for hemorrhage control and resuscitation. J Trauma Acute Care Surg. 2013;75(3):506-11.
  3. Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, Scalea T. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg. 2014;77(2):286-91.
  4. Megan Brenner & Scott Weingart discuss REBOA
  5. LITFL Critical Care Compendium reviews the nuts & bolts of REBOA

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Comments

  1. Hildy

    Do you have any experience with using a proglide for preclose like in EVAR? What about percutaneous insertion of the REBOA balloon followed by a cutdown repair?

  2. Oscar van Waes

    L.S.,

    is the BEST or ESTAR course still running, if so where can I sign in.

    best regards,

    LtCol Oscar JF van Waes
    military / trauma surgeon
    Erasmus University Medical Center, Rotterdam, The Netherlands

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