///2019 Abstract Details
2019 Abstract Details2019-07-13T07:45:15-05:00

Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in the management of hemorrhagic shock during pregnancy.

Abstract Number: RF1AA-120
Abstract Type: Case Report Case Series

Elysha Dinh MD1 ; Rishi Patel MD2; Brian Cocchiola MD3

Introduction

During pregnancy, the uterus receives an average of 700 mL blood flow/min, placing pregnant women with uterine bleeding at unique risk of rapid blood loss, hemorrhagic shock, and death. In these patients, REBOA should be considered as an adjunct for quick hemorrhage control during resuscitation.

Case report

41 year old G1 at 33 weeks by IVF dating presented with abdominal & back pain. Patient reported acute onset severe back pain and abdominal cramping associated with shortness of breath and blurred vision while having a bowel movement. There was no associated vaginal bleeding or LOF.

Upon arrival the patient was hypotensive and tachycardic with a positive FAST scan. Therefore, she was taken immediately to the OR with trauma surgery and obstetrics. The team initiated massive transfusion protocol. The OB service did a stat c-section via midline laparotomy followed by uterine closure and administration of intramuscular oxytocin and rectal misoprostol. The trauma surgery service then explored the abdomen, but found no obvious source of bleeding. The patient continued to be unstable despite receiving 21 units of PRBC, 9 FFP, 2 PLT and 1 Cryo, therefore the decision was made to place a REBOA via the left groin. The patient was transported to interventional radiology for angiography and possible embolization. In the IR suite, pelvic and abdominal angiography showed no evidence of active extravasation. However, empiric embolization of the bilateral uterine arteries was done as this was thought to be the most likely source. Following embolization, patient remained hemodynamically stable in the ICU and was able to return to the OR on POD 1 for re-opening laparotomy and primary fascial closure. Patient was discharged home on POD 22.

Discussion

REBOA is most often performed emergently to control blood flow proximal to the suspected bleeding focus and to provide circulatory support to bridge patients to definitive hemorrhage control. It is most commonly used in trauma surgery for hemorrhage control and as a resuscitation adjunct in patients with hemorrhagic shock at risk of circulatory collapse. However, its use is not limited to trauma alone; REBOA use has been reported in five major types of hemorrhage: postpartum, upper gastrointestinal, pelvic (during pelvic/sacral tumor surgery), abdominopelvic trauma, and ruptured AAA.

Interestingly, some cases have also described prophylactic REBOA placement in hemodynamically stable patients at risk of significant hemorrhage including patients undergoing pelvic and sacral tumor resection and high risk obstetric cases where bleeding would be rapid and difficult to quickly control.

References

Morrison J.J., Galgon R.E., Jansen J.O., Cannon J.W., Rasmussen T.E., Eliason J.L. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016;80(2):324–334. [PubMed]

SOAP 2019