Early Adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta

Early Adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta Research Original Investigation REBOA for Proximal Aortic Control in Severe Hemorrhage and Arrest Invited Commentary Early Adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta The Beginning of a Journey Joseph M. Galante, MD New ideas rely on innovators and early adopters to advance clear indications for its use, resuscitative thoracotomy is easier into mainstream practice. Brenner and colleagues at the R. Ad- and more practical, and there is only anecdotal evidence of its efficacy. Brenner et al ams Cowley Shock Trauma Center at the University of Mary- have shown the different scenarios in land are true early adopters. which REBOA can be applied. Algorithms with indications for Building on the innovation REBOA have been published by the US Military as a clinical 2 3 4 Related article page 130 of Hughes from the 1950s, practice guideline. Biffl et al published an algorithm for Brenner et al have applied REBOA use in exsanguinating hemorrhage. There needs to resuscitative endovascular balloon occlusion of the aorta be a concerted effort to clearly define when and in whom (REBOA) to the trauma and acute care surgery settings. Their REBOA should be used. Regarding comparison with thora- results are remarkable, but represent only the experience of cotomy, Moore et al compared REBOA with thoracotomy dur- early adopters at a single institution. ing an 18-month period, and, like Brenner, showed that the 2 In this issue of JAMA Surgery, Brenner et al show that procedures are comparable. Yes, these are not randomized REBOA offers a means of hemorrhage control in severe trau- clinical trials, but if perfect data were needed for a change in matic hemorrhage and is an alternative to resuscitative tho- practice, very little in trauma care would ever advance or racotomy in traumatic arrest. In addition, REBOA is de- change. A review of trauma literature from the past 5 years re- scribed for hemorrhage control in the setting of acute care veals very few randomized clinical trials. Owing to a lack of surgery of nontraumatic hemorrhage. funding and complex regulations related to patient consent, The American College of Surgeons Committee on Trauma much of trauma care is driven by surgeons’ experiences and has recognized the potential of REBOA. The Basic Endovas- retrospective studies. cular Skills in Trauma course, which began in 2016, gives gen- A Chinese proverb says, “A journey of a thousand miles be- eral surgeons the skill set required to quickly and safely place gins with a single step.” Brenner and colleagues are several a REBOA. The development and release of the Basic Endovas- steps into the journey, and their experience with REBOA gives cular Skills in Trauma course, along with the article by Brenner us insight into the future of trauma care if the technology et al, are 2 steps toward broader adoption of REBOA. can be widely adopted. This adoption would be hastened by Unfortunately, as with all new technologies, there are skep- improving trauma funding to prove to the skeptics, through tics. Those who are skeptical of REBOA argue that there are no well-designed trials, that this technology benefits patients. ARTICLE INFORMATION REFERENCES hemorrhagic shock. http://www.usaisr.amedd .army.mil/cpgs/REBOA_for_Hemorrhagic_Shock Author Affiliations: Division of Trauma, Acute Care 1. Brenner M, Teeter W, Hoehn M, et al. Use of _16Jun2014.pdf. Published June 16, 2014. Accessed Surgery, Surgical Critical Care, University of resuscitative endovascular balloon occlusion of the July 14, 2017. California, Davis, Sacramento; Department of aorta for proximal aortic control in patients with Surgery, University of California, Davis, Sacramento. severe hemorrhage and arrest [published online 4. Biffl WL, Fox CJ, Moore EE. The role of REBOA in September 27, 2017]. JAMA Surg. doi:10.1001 the control of exsanguinating torso hemorrhage. Corresponding Author: Joseph M. Galante, MD, /jamasurg.2017.3549 J Trauma Acute Care Surg. 2015;78(5):1054-1058. Department of Surgery, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817 2. Hughes CW. Use of an intra-aortic balloon 5. Moore LJ, Brenner M, Kozar RA, et al. (jmgalante@ucdavis.edu). catheter tamponade for controlling intra-abdominal Implementation of resuscitative endovascular hemorrhage in man. Surgery. 1954;36(1):65-68. balloon occlusion of the aorta as an alternative to Published Online: September 27, 2017. resuscitative thoracotomy for noncompressible doi:10.1001/jamasurg.2017.3552 3. US Army. Joint theater trauma system clinical truncal hemorrhage. J Trauma Acute Care Surg. practice guideline: resuscitative endovascular Conflict of Interest Disclosures: None reported. 2015;79(4):523-530. balloon occlusion of the aorta (REBOA) for 136 JAMA Surgery February 2018 Volume 153, Number 2 (Reprinted) jamasurgery.com © 2017 American Medical Association. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Surgery American Medical Association

Early Adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta

Free
1 page

Loading next page...
1 Page
 
/lp/jama/early-adoption-of-resuscitative-endovascular-balloon-occlusion-of-the-UyhtP0WS5N
Publisher
American Medical Association
Copyright
Copyright 2017 American Medical Association. All Rights Reserved.
ISSN
2168-6254
eISSN
2168-6262
D.O.I.
10.1001/jamasurg.2017.3552
Publisher site
See Article on Publisher Site

Abstract

Research Original Investigation REBOA for Proximal Aortic Control in Severe Hemorrhage and Arrest Invited Commentary Early Adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta The Beginning of a Journey Joseph M. Galante, MD New ideas rely on innovators and early adopters to advance clear indications for its use, resuscitative thoracotomy is easier into mainstream practice. Brenner and colleagues at the R. Ad- and more practical, and there is only anecdotal evidence of its efficacy. Brenner et al ams Cowley Shock Trauma Center at the University of Mary- have shown the different scenarios in land are true early adopters. which REBOA can be applied. Algorithms with indications for Building on the innovation REBOA have been published by the US Military as a clinical 2 3 4 Related article page 130 of Hughes from the 1950s, practice guideline. Biffl et al published an algorithm for Brenner et al have applied REBOA use in exsanguinating hemorrhage. There needs to resuscitative endovascular balloon occlusion of the aorta be a concerted effort to clearly define when and in whom (REBOA) to the trauma and acute care surgery settings. Their REBOA should be used. Regarding comparison with thora- results are remarkable, but represent only the experience of cotomy, Moore et al compared REBOA with thoracotomy dur- early adopters at a single institution. ing an 18-month period, and, like Brenner, showed that the 2 In this issue of JAMA Surgery, Brenner et al show that procedures are comparable. Yes, these are not randomized REBOA offers a means of hemorrhage control in severe trau- clinical trials, but if perfect data were needed for a change in matic hemorrhage and is an alternative to resuscitative tho- practice, very little in trauma care would ever advance or racotomy in traumatic arrest. In addition, REBOA is de- change. A review of trauma literature from the past 5 years re- scribed for hemorrhage control in the setting of acute care veals very few randomized clinical trials. Owing to a lack of surgery of nontraumatic hemorrhage. funding and complex regulations related to patient consent, The American College of Surgeons Committee on Trauma much of trauma care is driven by surgeons’ experiences and has recognized the potential of REBOA. The Basic Endovas- retrospective studies. cular Skills in Trauma course, which began in 2016, gives gen- A Chinese proverb says, “A journey of a thousand miles be- eral surgeons the skill set required to quickly and safely place gins with a single step.” Brenner and colleagues are several a REBOA. The development and release of the Basic Endovas- steps into the journey, and their experience with REBOA gives cular Skills in Trauma course, along with the article by Brenner us insight into the future of trauma care if the technology et al, are 2 steps toward broader adoption of REBOA. can be widely adopted. This adoption would be hastened by Unfortunately, as with all new technologies, there are skep- improving trauma funding to prove to the skeptics, through tics. Those who are skeptical of REBOA argue that there are no well-designed trials, that this technology benefits patients. ARTICLE INFORMATION REFERENCES hemorrhagic shock. http://www.usaisr.amedd .army.mil/cpgs/REBOA_for_Hemorrhagic_Shock Author Affiliations: Division of Trauma, Acute Care 1. Brenner M, Teeter W, Hoehn M, et al. Use of _16Jun2014.pdf. Published June 16, 2014. Accessed Surgery, Surgical Critical Care, University of resuscitative endovascular balloon occlusion of the July 14, 2017. California, Davis, Sacramento; Department of aorta for proximal aortic control in patients with Surgery, University of California, Davis, Sacramento. severe hemorrhage and arrest [published online 4. Biffl WL, Fox CJ, Moore EE. The role of REBOA in September 27, 2017]. JAMA Surg. doi:10.1001 the control of exsanguinating torso hemorrhage. Corresponding Author: Joseph M. Galante, MD, /jamasurg.2017.3549 J Trauma Acute Care Surg. 2015;78(5):1054-1058. Department of Surgery, University of California, Davis, 2315 Stockton Blvd, Sacramento, CA 95817 2. Hughes CW. Use of an intra-aortic balloon 5. Moore LJ, Brenner M, Kozar RA, et al. (jmgalante@ucdavis.edu). catheter tamponade for controlling intra-abdominal Implementation of resuscitative endovascular hemorrhage in man. Surgery. 1954;36(1):65-68. balloon occlusion of the aorta as an alternative to Published Online: September 27, 2017. resuscitative thoracotomy for noncompressible doi:10.1001/jamasurg.2017.3552 3. US Army. Joint theater trauma system clinical truncal hemorrhage. J Trauma Acute Care Surg. practice guideline: resuscitative endovascular Conflict of Interest Disclosures: None reported. 2015;79(4):523-530. balloon occlusion of the aorta (REBOA) for 136 JAMA Surgery February 2018 Volume 153, Number 2 (Reprinted) jamasurgery.com © 2017 American Medical Association. All rights reserved.

Journal

JAMA SurgeryAmerican Medical Association

Published: Feb 27, 2018

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off