Minimally Invasive Surgical Technique Limits Blood Loss by Partially Blocking Aorta

Image: A multicenter observational study will look at a procedure to limit blood loss by partially blocking the aorta (Photo courtesy of Shutterstock))

Hemorrhagic shock, a condition where severe blood loss compromises the body’s ability to supply oxygen to its cells, is the main cause of death after traumatic injuries. Specifically, treating injuries to non-compressible areas like the torso and abdomen presents a difficult clinical problem, as there are limited ways to control bleeding without further injuring the body. Some trauma centers globally employ Endovascular Hemorrhage Control (EHC) devices and minimally invasive methods. Among these is the partial resuscitative endovascular balloon occlusion of the aorta (REBOA), a technique involving the placement of a balloon in the aorta to limit blood flow beneath the heart and control severe bleeding. Now, a team of acute care surgeons is planning a study to evaluate the effectiveness and safety of using REBOA for hemorrhage control.

Acute care surgeons at Vanderbilt University Medical Center (Nashville, TN, USA) are leading a two-year, multicenter observational study on REBOA. This procedure involves feeding a small catheter equipped with a balloon through the femoral artery, and positioning it within the aorta— the body’s largest artery. When inflated, the balloon restricts the blood flow below the aorta and helps stabilize blood pressure, allowing life to be sustained while addressing the root cause of the bleeding. REBOA received FDA approval in 2017, and the latest version of this device allows for controlling partial blood flow to the rest of the body. This is anticipated to minimize risk and provide medical teams with additional time to surgically halt the bleeding.

Although REBOA has been shown to be effective in controlling blood loss, it comes with some risks. Limiting blood flow for extended periods can lead to ischemia-reperfusion injuries or tissue damage that occurs when blood supply is restored to the tissue. The most frequent complication arising from REBOA is acute kidney injury (AKI) which can affect as many as 40% of individuals who survive hemorrhagic shock and undergo REBOA treatment.

“We believe from our experience with the device that it clearly has benefits, but we want to fine-tune this procedure so we can provide the maximum benefit for the greatest number of patients,” said co-principal investigator Bradley Dennis, MD, associate professor of Surgery and medical director of VUMC’s Trauma Intensive Care Unit. “Doing this now, in a controlled fashion with a limited number of trauma centers, will help us standardize partial REBOA use and identify the best practices so we can then help spread that information to the rest of the country.”

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Vanderbilt University Medical Center