TY - JOUR
T1 - To ultrasound or not to ultrasound
T2 - A reboa femoral access analysis from the abotrauma and aorta registries
AU - Duchesne, Juan
AU - McGreevy, David
AU - Nilsson, Kristofer
AU - Dubose, Joseph
AU - Rasmussen, Todd E.
AU - Brenner, Megan
AU - Jacome, Tomas
AU - Hörer, Tal
AU - Tatum, Danielle
N1 - Publisher Copyright:
© 2020.
PY - 2020
Y1 - 2020
N2 - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral access has been taught as the best practice for femoral artery cannulation. However, there is a lack of evidence to support its use in patients in extre-mis with severe hemorrhage. We hypothesize that no differences in outcome will exist between US-guided and to blind percutaneous or cutdown access methods. Methods: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes were compared among puncture access methods. Significance was set at P < 0.05. Results: The cohort included 523 patients, primarily male (74%), blunt injured (77%), with median age 40 (27–58), and an Injury Severity Score of 34 (25–45). Percutaneous using external landmarks/palpation was the most common femoral puncture method (53%) used followed by US-guided (27.9%). There was no significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality (47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24 hour mortality (P = 0.002), and in-hospital mortality (P = 0.007). Conclusions: In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach using anatomic landmarks and palpation, when compared with US-guided femoral access, was used more frequently with-out an increase in complications, access attempts, or mortality.
AB - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct in the management of non-compressible hemorrhage. Ultrasound (US)-guided femoral access has been taught as the best practice for femoral artery cannulation. However, there is a lack of evidence to support its use in patients in extre-mis with severe hemorrhage. We hypothesize that no differences in outcome will exist between US-guided and to blind percutaneous or cutdown access methods. Methods: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. REBOA characteristics and outcomes were compared among puncture access methods. Significance was set at P < 0.05. Results: The cohort included 523 patients, primarily male (74%), blunt injured (77%), with median age 40 (27–58), and an Injury Severity Score of 34 (25–45). Percutaneous using external landmarks/palpation was the most common femoral puncture method (53%) used followed by US-guided (27.9%). There was no significant difference in overall complication rates (37.4% vs 34.9%; P = 0.615) or mortality (47.8% vs 50.3%; P = 0.599) between percutaneous and US-guided methods; however, access by cutdown was significantly associated with emergency department (ED) mortality (P = 0.004), 24 hour mortality (P = 0.002), and in-hospital mortality (P = 0.007). Conclusions: In patients with severe hemorrhage in need of REBOA placement, the percutaneous approach using anatomic landmarks and palpation, when compared with US-guided femoral access, was used more frequently with-out an increase in complications, access attempts, or mortality.
KW - Arterial Access
KW - Femoral Artery
KW - Non-compressible Torso Hemorrhage
KW - Resuscitative Balloon Occlusion of the Aorta
UR - http://www.scopus.com/inward/record.url?scp=85098279336&partnerID=8YFLogxK
U2 - 10.26676/jevtm.v4i2.139
DO - 10.26676/jevtm.v4i2.139
M3 - Article
AN - SCOPUS:85098279336
SN - 2002-7567
VL - 4
SP - 80
EP - 87
JO - Journal of Endovascular Resuscitation and Trauma Management
JF - Journal of Endovascular Resuscitation and Trauma Management
IS - 2
ER -