Temporary hemodynamic response with resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation in a case of traumatic cardiac arrest

Uncontrolled hemorrhagic shock due to trauma is a life-threatening condition requiring rapid intervention. Every minute in the man-agement of these patients is valuable. In recent years, resuscitative endovascular aortic balloon occlusion (REBOA) has emerged as a valuable tool in emergency and trauma practice, providing additional time for the patient, particularly in cases where surgical hemosta-sis is delayed. A 62-year-old male patient with no known comorbidities was transported to our tertiary trauma center after receiving five minutes of cardiopulmonary resuscitation (CPR) and intubation at an external facility following a high-energy traffic accident. Upon presentation, the patient's blood pressure was 50/20 mmHg and pulse rate was 128 beats/min. He had extensive pelvic trauma, lower extremity trauma, major soft tissue loss, and vascular and bone injuries. He underwent hemostatic resuscitation along with whole-body computed tomography (CT) imaging; however, cardiac arrest recurred after imaging. During CPR, simultaneous imaging studies revealed no trauma or bleeding in the brain or thorax. REBOA was planned for the patient. Temporary return of spontaneous circula-tion (ROSC) was achieved 38 minutes after REBOA. During this period, the patient received a total of six units of packed red blood cells, three units of fresh frozen plasma, two units of cryoprecipitate, and calcium replacement. The REBOA procedure was performed by emergency physicians and cardiovascular surgeons who had received hands-on training using a REBOA simulation model developed by our team. However, despite achieving a temporary hemodynamic response, the patient could not be stabilized for surgical interven-tion and was pronounced deceased. In this case, we share the first REBOA experience of emergency department physicians trained with a locally produced simulation model. We believe that simulation-based training will contribute to physician experience and direct field application in rare or rapidly evolving emergencies.

Keywords: Resuscitative endovascular balloon occlusion of the aorta (REBOA), simulation training, cardiopulmonary resuscitation (CPR), trauma, hemorrhagic shock, iliac artery injury.

Travmatik kardiyak arrest olgusunda kardiyopulmoner resüsitasyon sýrasýnda REBOA ile geçici hemodinamik yanýt

Travmaya baðlý kontrolsüz hemorajik þok, hýzlý müdahale gerektiren yaþamý tehdit eden bir durumdur. Bu hastalarýn yönetimindeki her bir dakika altýn deðerindedir. Son yýllarda resüsitatif endovasküler aort balon oklüzyonu (REBOA), özellikle cerrahi hemostazýn geciktiði durumlarda hastaya ek zaman kazandýrarak acil ve travma pratiðinde deðerli bir araç olarak öne çýkmaktadýr. Bilinen ek hastalýðý olmayan 62 yaþýnda erkek hasta, yüksek enerjili bir trafik kazasý sonrasý götürüldüðü dýþ merkezde 5 dakika kardiyopulmoner resüsitasyon (KPR) uygulandýktan ve entübe edildikten sonra üçüncü basamak travma merkezimize sevk edilmiþtir. Hastanýn baþvuru anýndaki kan basýncý 50/20 mmHg, nabýz 128 atým/dakika idi. Hastada geniþ pelvik travma, alt ekstremite travmasý, majör yumuþak doku kaybý, vasküler ve kemik yaralanmalarý mevcuttu. Hemostatik resüsitasyonla birlikte tüm vücut tomografi görüntülemesi yapýlan hastada görüntüleme sonrasýnda tekrar kardiyak arrest geliþti. KPR sýrasýnda eþ zamanlý görüntüleme tetkikleri de incelenen hastada beyin ve toraks bölgesinde travma ve kanama tespit edilmedi ve hastaya REBOA uygulanmasý planlandý. REBOA uygulandýktan 38 dakika sonra geçici spontan dolaþým dönüþü (ROSC) saðlandý. Hastaya bu süreçte toplam 6 ünite eritrosit süspansiyonu, 3 ünite taze donmuþ plazma, 2 ünite kriyopresipitat ve kalsiyum replasmaný yapýldý. REBOA iþlemi, ekibimiz tarafýndan geliþtirilen REBOA simülasyon modeli ile uygulamalý eðitim almýþ acil týp hekimleri ve kalp damar cerrahi hekimleri tarafýndan gerçekleþtirildi. Ancak geçici hemodinamik yanýt saðlanmasýna raðmen hasta cerrahi müdahale için stabilize edilememiþ ve eksitus kabul edilmiþtir. Bu vakada yerel olarak üretilmiþ bir simulasyon modeli ile eðitil-miþ Acil servis hekimlerinin ilk REBOA deneyimi paylaþýldý. Nadir görülen veya hýzlý müdahale edilmesi gereken acil durumlarda simulasyon temelli eðitimlerin hekim deneyimi kazanmasýnda ve doðrudan saha uygulamasýna katký saðlayacaðýný düþünmekteyiz.

Anahtar Kelimeler: REBOA, simülasyon eðitimi, KPR, travma, hemorajik þok, iliak arter yaralanmasý