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

REBOA- Magic Bullet for Obstetric Hemorrhage

Abstract Number: RF2BB-201
Abstract Type: Case Report Case Series

Jasper Cumbee MD1 ; Joel Sirianni MD2; Robert Harvey MD3; Latha Hebbar MD, FACS4

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive technique to temporarily occlude the aorta in situations of anticipated or on-going hemorrhage. We report a case of placenta increta with REBOA deployment. 31yoF G2P1 at 35w0d BMI 26 (1 previous cesarean delivery [CD] for placental abruption) with suspected abnormal placentation involving bladder dome and cervix, was scheduled for a CD with possible hysterectomy. Preoperative Labs: Plts 178/Hgb10.6/Hct 30.9/WBC 7.95. Anesthesia plan included 8.5 Fr RIC x2, radial A-line and CSE for fetal delivery followed by induction of GA in the event of hysterectomy. Following placement of a 7F arterial sheath into the right common femoral artery, the balloon catheter was floated into Zone 3 of the aorta by the trauma surgeon and the arterial tracing was transduced. After placement of bilateral ureteral stents, CD commenced. Placenta increta was noted, with no invasion into the bladder and the fetus was delivered through a classical fundal hysterotomy. GA was induced and maintained with TIVA and pitocin commenced. Within 6 minutes of delivery, blood loss was 2L. REBOA was deployed and remained inflated for 16 minutes while the surgeons performed the hysterectomy in an expedited manner. Patient remained stable during REBOA deflation. Total EBL was 4 L with transfusion of 8 units of PRBC and 8 units of FFP, 1 gm TXA and 1.5 GM calcium chloride. Patient was extubated at the end of the case, transferred to STICU for observation of perfusion of her right extremity and had an uneventful postoperative course. Discussion: REBOA involves placement of an endovascular balloon in the aorta to control hemorrhage and to augment afterload in hemorrhagic shock states. Advantages include less physiological disturbance and higher rates of technical success than aortic cross clamping. The aorta is divided into three separate zones for the purposes of REBOA. Zone I extends from the origin of the left subclavian artery to the celiac artery, Zone II from the celiac artery to the most caudal renal artery, and Zone III (target Zone for OB cases) from the most caudal renal artery to the aortic bifurcation. Contraindications in the obstetric population includes femoral vessels not immediately identifiable on ultrasound, cardiac arrest due to causes other than exsanguination, PEA arrest >10 minutes, high suspicion of proximal traumatic aortic dissection. Complications include bleeding, infection, abscess, injury to adjacent structures, vascular complications (dissection, occlusion, pseudoaneurysm), and post-deflation cardiopulmonary compromise. While high quality evidence for decrease in hemorrhage-related mortality with REBOA in trauma settings is currently lacking, it is probably a practical interventional accessory in high-risk OB cases with abnormal placentation to reduce morbidity/mortality.

SOAP 2019