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Master Thesis

Ballon d'occlusion intra-aortique dans la prise en charge de l'hémorragie critique chez le traumatisé sévère : une analyse rétrospective au CHU de Grenoble

Abstract : Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as a non-invasive clamp of the aorta after diverse post-traumatic injuries. Balloon inflation in zone 3 can be performed to stop on-going bleeding after severe pelvic trauma with life-threatening hemorrhage. The aim of our study was to describe our 20-year experience with REBOA use in terms of efficacy and safety in this indication. We performed a retrospective study from 1996 to 2017 in a French Level-I trauma center. All consecutive patients who underwent a REBOA procedure were included. REBOA indication relied on 1) extreme hemodynamic instability (systolic arterial blood pressure (SBP) < 60 mmHg on admission, SBP < 90 mmHg despite initial resuscitation or post-traumatic cardiac arrest) and 2) positive pelvic X-ray. Efficacy endpoints were vital signs and coagulation parameters before and after balloon inflation. Safety endpoints were REBOA-related complications. Within the study period, 32 patients underwent a REBOA procedure. Nineteen patients did not survive at Day 28. REBOA significantly improved SBP from 60 [35-73] mmHg to 115 [91-128] mmHg (p<0.001). We reported a high rate of vascular complications (19%, n= 5 patients) but no amputation. Renal replacement therapy was initiated in eleven patients and fifteen patients had severe rhabdomyolysis. REBOA is safe and effective in improving hemodynamics after severe pelvic trauma and life-threatening hemorrhage. Our study supports the use of REBOA as a bridge to definitive hemostatic treatment after severe pelvic trauma.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02420613
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Audrey Pieper. Ballon d'occlusion intra-aortique dans la prise en charge de l'hémorragie critique chez le traumatisé sévère : une analyse rétrospective au CHU de Grenoble. Human health and pathology. 2017. ⟨dumas-02420613⟩

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