SUCCESSFUL UTILIZATION OF RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA, REBOA, IN A PEDIATRIC PATIENT

Objectives: With more than half of pediatric trauma deaths occurring within 24 hours of injury, it is imperative that severe injuries be managed in a timely fashion. Resuscitative Endovascular Balloon Occlusion of the Aorta, REBOA, can be useful to control hemorrhage below the diaphragm and can be placed rapidly in the trauma bay. Although using REBOA in the pediatric population is currently controversial, it may be a useful and practical technique to use in times where there is an immediate need to achieve hemodynamic stability. This case describes the use of REBOA in a pediatric patient after sustaining multi-system blunt traumatic injuries accompanied by hemorrhagic shock.

Methods: A 14-year-old female presented to an urban Level 1 trauma center after being involved in a high-speed motor vehicle collision. Upon arrival, profound hemodynamic instability and low GCS were indicative of severe injuries. Further assessment deemed she met criteria for REBOA catheter placement in the trauma bay due to suspected hemorrhagic shock from non-compressible torso hemorrhage. An ER-REBOATM was inserted into the common femoral artery using ultrasound guidance and ultimately placed into zone one. She was taken directly from the trauma bay to the operating room for an exploratory laparotomy, where hemoperitoneum and a large liver laceration were found. Massive transfusion protocol was initiated along with peri-hepatic packing, and the abdomen was left open. With bleeding controlled, she was then transferred to the pediatric intensive care unit (PICU) for further resuscitation. CT imaging revealed extensive traumatic brain injury, including subarachnoid hemorrhage, diffuse sulcal effacement with diminished loss of white-gray differentiation, and cerebellar tonsillar herniation. These imaging findings along with her poor neurologic exam suggested a non-survivable brain injury.

Results: Once hemodynamic stability and hemorrhage control were assured, the REBOA sheath was removed without incident at the bedside. After brain death was confirmed, her family agreed to organ donation.

Conclusion: Resuscitative Endovascular Balloon Occlusion of the Aorta can be safely used in pediatric patients. The presented case shows REBOA can temporarily stabilize massively hemorrhaging pediatric trauma patients and provide time for definitive hemorrhage control. In this particular case, organ donation would likely not have been possible without the rapid hemostasis accomplished by use of REBOA in the trauma bay.