Consensus on resuscitative endovascular balloon occlusion of the Aorta: A first consensus paper using a Delphi method |
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| Institution: | 1. Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands;2. Department of Trauma, Hillel Yaffe Medical Center, Hadera, Israel;3. R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA;4. Department of Cardiothoracic and Vascular Surgery, Faculty of Life Science Örebro University Hospital, Örebro, Sweden;5. Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands;6. Leiden University Medical Centre, Leiden, the Netherlands;1. Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;2. Department of Surgery, University of Michigan Medical School, Ann Arbor, MI, USA;3. Michigan Center for Integrative Research in Critical Care, University of Michigan Medical School, Ann Arbor, MI, USA;1. Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan;2. Department of Emergency Medicine, Jichi Medical University, Tochigi, Japan;3. Department of Surgery, Jichi Medical University, Tochigi, Japan;1. Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware;2. Division of Trauma Surgery, Department of Surgery, Christiana Care Health System, Newark, Delaware;3. Virtual Education and Simulation Training Center, Christiana Care Health System, Newark, Delaware;1. Academic Department of Trauma and Orthopaedics, Floor A, Clarendon Wing, LGI, University of Leeds, Leeds, UK;2. NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK |
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| Abstract: | BackgroundTo further strengthen the evidence base on the use of Resuscitative Endovascular Balloon occlusion of the Aorta (REBOA) we performed a Delphi consensus. The aim of this paper is to establish consensus on the indications and contraindications for the use of REBOA in trauma and non-trauma patients based on the existing evidence and expertise.Study DesignA literature review facilitated the design of a three-round Delphi questionnaire. Delphi panelists were identified by the investigators. Consensus was reached when at least 70% of the panelists responded to the survey and more than 70% of respondents reached agreement or disagreement.ResultsPanel members reached consensus on potential indications, contra-indications and settings for use of REBOA (excluding the pre hospital environment), physiological parameters for patient selection and indications for early femoral access. Panel members failed to reach consensus on the use of REBOA in patients in extremis (no pulse, no blood pressure) and the use of REBOA in patients with two major bleeding sites.ConclusionsConsensus was reached on indications, contra indications, physiological parameters for patient selection for REBOA and early femoral access. The panel did not reach consensus on the use of REBOA in patients in pre-hospital settings, patients in extremis (no pulse, no blood pressure) and in patients with 2 or more major bleeding sites. Further research should focus on the indications of REBOA in pre hospital settings, patients in near cardiac arrest and REBOA inflation times. |
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| Keywords: | REBOA Delphi consensus Indications contra indications |
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