Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK Combat casualties

Morrison, Jonathan J., Ross, James D., Rasmussen, Todd E., Midwinter, Mark J. and Jansen, Jan O. (2014) Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK Combat casualties. Shock, 41 5: 388-393. doi:10.1097/SHK.0000000000000136


Author Morrison, Jonathan J.
Ross, James D.
Rasmussen, Todd E.
Midwinter, Mark J.
Jansen, Jan O.
Title Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK Combat casualties
Journal name Shock   Check publisher's open access policy
ISSN 1073-2322
1540-0514
Publication date 2014-05-01
Sub-type Article (original research)
DOI 10.1097/SHK.0000000000000136
Open Access Status Not yet assessed
Volume 41
Issue 5
Start page 388
End page 393
Total pages 6
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Abstract The control of torso and junctional zone bleeding in combat casualties is particularly challenging because of its noncompressible nature. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has demonstrated promise in translational large animal and early clinical series as an effective resuscitation and hemorrhage control adjunct. However, it is unknown what proportion of combat casualties has an injury pattern and clinical course that is amenable to REBOA deployment. The prospective UK Joint Theatre Trauma Registry was used to retrospectively identify all UK military personnel who has sustained a severe combat injury, defined as an Abbreviated Injury Scale of three or greater, in the course of 10 years. Patients were then divided into three groups based on Abbreviated Injury Scale injury pattern: no indications for REBOA, contraindications (mediastinal, cervical, and axillary hemorrhage), and indications (torso and pelvic hemorrhage). From a total of 1,317 patients, 925 (70.2%) had no indication, 148 (11.2%) had a contraindication, and 244 (18.5%) had an indication for REBOA. Within the group with indications for REBOA, there were 174 deaths: 79 at the point of wounding, 66 en route to hospital, and 29 in-hospital deaths. The median (interquartile range) time to death in patients dying en route was 75 (42–109) min, and the median prehospital time for casualties admitted to hospital was 61 (34–89) min. One-in-five severely injured UK combat casualties have a focus of hemorrhage in the abdomen or pelvic junctional region potentially amenable to REBOA deployment. The UK military should explore REBOA as a potential en route hemorrhage control and resuscitation adjunct.
Keyword Noncompressible torso hemorrhage
Improvised explosive devices
En-route care
Shock
Epidemiology
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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