When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

Yevgeniya J M Ioffe; Sigrid Burruss; Ruofan Yao; Beverly Tse; Alicia Cryer; Kaushik Mukherjee; Linda J Hong

doi:10.1136/tsaco-2021-000750

When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders

Trauma Surg Acute Care Open. 2021 Aug 13;6(1):e000750. doi: 10.1136/tsaco-2021-000750. eCollection 2021.

Authors

Yevgeniya J M Ioffe¹, Sigrid Burruss², Ruofan Yao³, Beverly Tse⁴, Alicia Cryer⁴, Kaushik Mukherjee^{2

5}, Linda J Hong¹

Affiliations

¹ Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, California, USA.
² Department of Surgery, Divisions of Acute Care Surgery and Critical Care, Loma Linda University Medical Center, Loma Linda, California, USA.
³ Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA.
⁴ Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, California, USA.
⁵ Loma Linda University Medical Center.

Abstract

Background: Patients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.

Methods: We conducted a retrospective case-control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.

Results: 90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).

Discussion: Decrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.

Level of evidence: IV.

Keywords: abdomen; aorta; blood transfusion; iliac artery.