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January 1, 2021: The year following COVID19 Global Pandemic brings us a new horizon – lets appreciate what has happened, learn from our mistakes and begin to look forward.
In this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Dr. Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage.
Dr. Qasim is a world expert in REBOA and has been on the podcast:
edecmo.org/35 – REBOA revisited
edecmo.org/49 – the ACEP-ACS joint statement controversy
REBOA in Hemorrhagic Shock from NON-Trauma Mechanisms:
This episode is highlighted by a remarkable case, managed by Emergency Physician Dr. Garrett Sterling, of a 77 year old patient who suffered non-traumatic hemorrhagic shock from an Iliac artery pseudo-aneurysm that had fistulized to the urinary tract. The patient was bleeding to death from a fistula between the common iliac artery and the ureter. You have to listen to Dr. Sterling describe this case. The patient was resuscitated with REBOA and her pathology was fixed by an Iliac Artery stent placed in Interventional Radiology. We discuss this case which highlights the benefit of REBOA as a bridge to definitive hemorrhage control.
Amazing patient who had an Iliac pseudo-aneurysm causing hemorrhagic shock through the urinary tract, resuscitated using REBOA.
Joe and Zaf talk about:
- brief history of managing hemorrhagic shock with aortic occlusion
- ‘Knee REBOA’
- Resuscitative thoracotomy
- REBOA in trauma
- REBOA in non-trauma hemorrhagic shock
REFERENCES:
https://pubmed.ncbi.nlm.nih.gov/29922894/
https://pubmed.ncbi.nlm.nih.gov/31799415/
https://pubmed.ncbi.nlm.nih.gov/32707397/
https://pubmed.ncbi.nlm.nih.gov/31668242/
https://tsaco.bmj.com/content/4/1/e000376
https://pubmed.ncbi.nlm.nih.gov/29421694/
Click to access 20202110O’Dochartaigh.pdf
Over the last several years, data has suggested that partial or intermittent REBOA may have benefit over complete REBOA. How to do this and how to use our current imperfect catheters in this arena is still in question. Dr. Matthew Martin and his colleagues at Madigan Medical Center have published the first study using Prytime’s new catheter for partial REBOA. Zack interviews Matt in this episode about this latest paper in Journal of Trauma and Acute Surgery as well as several other papers he’s published in the field. Dr. Martin is extensively published in the field and offers his insight in the specific flows that maximize survival within the conflicting problems of hemorrhagic shock and lower body ischemia.
#tbs19 The Big Sick—- You’ve heard of ECMO for cardiac arrest- utilizing a mechanical pump to aid in perfusion of the coronaries. What if you can’t do ECMO? What if your resources are such that simply can’t lug a 10 kilogram machine out into the field? Well, Jostein Brede may have something for you to consider. He and several other places worldwide are on the forefront of using a REBOA catheter to occlude the proximal aorta during chest compressions in hopes that coronary perfusion pressure increases. This would subsequently improve chance of return of spontaneous circulation and overall survivorship. Maybe this is the band-aid that can be used in austere environments like rural Norway where the temperatures are extreme, the people are sparse, but the physicians are motivated. 
as well as Shock Trauma in Baltimore and teaches at Reanimate. When you come to the essence of this episode, the question is what is the emergency physician’s role in the trauma resuscitation? Both Zaf and Zack agree; we need to be the resuscitationist in the trauma suite. We need to manage the airway and then quickly take over the arterial and venous access, interpret the transduced pressures, manage the massive transfusion protocol and be ready to insert the REBOA catheter while the trauma surgeon is involved with the left chest, the source of bleeding and where the next destination for this patient will be.
