• Carlos A Ordoñez, Michael W Parra, Ramiro Manzano-Nunez, Juan P Herrera-Escobar, Jose J Serna, Paola Rodriguez Ossa, David Mejia, Ana M Del Valle, Alexander Salcedo, Juan C Salamea, and Fernando Rodriguez.
• From the Division of Trauma and Acute Care Surgery, Department of Surgery (C.A.O., R.M.-N., P.R.O., F.R.), Fundación Valle del Lili, Cali, Colombia; Department of Trauma Critical Care (M.W.P.), Broward General Level I Trauma Center, Fort Lauderdale, FL; Clinical Research Center (R.M.-N.), Fundacion Valle del Lili, Cali, Colombia; Center for Surgery and Public Health, Department of Surgery (J.P.H.-E.), Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA; Trauma and Acute Care Surgery Fellowship (C.A.O., J.J.S., A.M.D.V., A.S.), Universidad del Valle, Cali, Colombia; Division of Trauma and Acute Care Surgery (D.M.), Universidad de Antioquia, Medellín, Colombia; and Division of Trauma and Emergency Surgery, Department of Surgery (J.C.S.), Hospital Vicente Corral Moscoso and Universidad del Azuay, Cuenca, Ecuador.
• J Trauma Acute Care Surg. 2018 May 1; 84 (5): 752-757.

BackgroundRecent evidence suggests that resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective life-saving intervention in patients with severe torso trauma. However, the deployment of REBOA in patients with isolated penetrating intrathoracic injuries remains controversial. We propose that a median sternotomy be performed in conjunction with REBOA as a feasible and effective means of hemorrhage control in patients suffering from penetrating chest trauma who present hemodynamically unstable. The objective of our study was to present our initial experience with this approach.MethodsA prospectively collected case series of the use of REBOA (10 Fr) in conjunction with a median sternotomy from January 2015 to December 2016 at a Level I Trauma Center. We included hemodynamically unstable non-compressible torso hemorrhage patients with penetrating chest trauma who underwent intraoperative REBOA deployment plus median sternotomy.ResultsA total of 68 trauma-related emergent thoracic surgeries were performed at our institution during the study period. Of these, seven suffered from penetrating chest trauma and non-compressible torso hemorrhage and underwent REBOA plus median sternotomy. Six out of the seven patients suffered intrathoracic vascular injuries: two subclavian arteries, two internal mammary arteries, two aortic arch, and five major central venous injuries. Four patients had an associated lung injury with AIS >3, of which two suffered a pulmonary hilar vessel disruption. REBOA-related complications included one case of upper gastrointestinal bleeding. Six out of the seven patients survived the 30-day follow-up. No adverse neurologic outcomes or deficits were observed in survivors.ConclusionThe combined use of REBOA and median sternotomy could be a feasible and effective alternative to hemorrhage control in patients with non-compressible torso hemorrhage secondary to penetrating chest trauma. These findings challenge the recommendation against the use of REBOA in penetrating intrathoracic injuries. Future studies with stronger designs and larger sample sizes are required to confirm our results.Level Of EvidenceTherapeutic, level V.

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