Strategies for successful implementation of resuscitative endovascular balloon occlusion of the aorta in an urban Level I trauma center

• Published in: The journal of trauma and acute care surgery Vol. 91; no. 2; pp. 295 - 301
• Main Authors: Hadley, Jamie B., Coleman, Julia R., Moore, Ernest E., Lawless, Ryan, Burlew, Clay C., Platnick, Barry, Pieracci, Fredric M., Hoehn, Melanie R., Coleman, Jamie J., Campion, Eric M., Cohen, Mitchell J., Cralley, Alexis, Eitel, Andrew P., Bartley, Matthew, Vigneshwar, Navin, Sauaia, Angela, Fox, Charles J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-08-2021
• ISSN: 2163-0755; 2163-0763
• DOI: 10.1097/TA.0000000000003198

The rationale for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is to control life-threatening sub-diaphragmatic bleeding and facilitate resuscitation, however, incorporating this into the resuscitative practices of a trauma service remains challenging. The objective of this study is to describe the process of successful implementation of REBOA use in an academic urban level I trauma center. All REBOA procedures from April 2014 through December 2019 were evaluated; REBOA was implemented after surgical faculty attended a required and internally developed Advanced Endovascular Strategies for Trauma Surgeons course (AESTS). Success was defined by sustained early adoption rates.
An institutional protocol was published, and a REBOA supply cart was placed in the emergency department(ED) with posters attached to depict technical and procedural details. A focused professional practice evaluation was utilized for the first three REBOA procedures performed by each faculty member, leading to internal privileging.
REBOA was performed in 97 patients by 9 trauma surgeons, which is 1% of the total trauma admissions during this time. Each surgeon performed a median of 12 REBOAs (IQR: 5,14). Blunt (77/97, 81%) or penetrating abdominopelvic injuries (15/97, 15%) comprised the main injury mechanisms; 4% were placed for other reasons (4/97) including ruptured abdominal aortic aneurysms (AAA, n=3) and pre-operatively for a surgical oncologic resection (n=1). Overall survival was 65% (63/97) with a steady early adoption trend that resulted in participation in a Department of Defense (DoD) multicenter trial.
Strategies for how departments adopt new procedures require clinical guidelines, a training program focused on competence, and a hospital education and privileging process for those acquiring new skills.
Level V.
Original Article, Diagnostic.