M.O.A.B.

I am aware of case reports of how various balloon catheters have been used to stop arterial bleeds. I didn’t know they have been used to plug the big one, the aorta. Apparently they do. I got this from a colleague who is working on publishing a series of case reports. I can’t disclose any of his conclusions, writing or results yet as his article is still in press, but here is his brief description of the technique and some pointers too.

Technique
The technique for controlling PPH or pelvic bleeds with an occlusion catheter is simple. In theory anyway…

They start by percutaneously inserting a occlusion catheter guide-wire into the femoral artery.

Then they pass the balloon catheter over the guide-wire about 30cm up the artery.

After passing the femoral bifurcation the balloon is inflated. Then the balloon is pulled back until it is wedged in the femoral bifurcation.

Now hopefully any bleeding below the inflated balloon is controlled.

Who?
An interventional radiologist ‘invented’ the technique I read up on, but the procedure should, on a vital indication, be a realistic option for anyone who is comfortable with inserting femoral arterial lines.

When?
There are some cases reported. (See refs below)
• Post partum hemorrhage – Several cases described.
• Ruptured abdominal aortic aneurysm. – A few cases described.
• Traumatic pelvic bleeds or from the lower extremities  – At least one case described.

Risks?
• Aortic intimal lesions or puncture
• Arterial thromboembolism or infections
• Occlusion of renal arteries – The kidneys tolerate up to 60 minutes of hot ischaemia.
• Occlusion of Adamkiewics artery. Risk of paraplegia or nerve injury.

The future
I’m sure I can fit a balloon occlusion catheter in one of my flight suit pockets…

Some references
‘Balloon occlusion of the decending aorta in the treatment of severe postpartum haemorrhage’
Aust Nz J Obstet Gynecol 2004;44:170-171

‘Aortic Occlusion Ballon Catheter Technique Is Useful for Uncontrollable Massive Intraabdominal Bleeding After Hepato-Pancreatico-Biliary Surgery’
J Gastrointest surg 2006;10:519-522

‘Case of traumatically bleeding shock patient rescued by using an aortic occlusion balloon catheter during surgery’
Masui 2006;55(8):1011-3 (japansk)

‘Elective Use of Aortic Ballon Occlusion in Caeserean Hysterectomy for Placenta previa Precreta’
Gynecol Obstet Invest 2009;67:92-95

And, of course, the vascular surgeons use them:
Techniques in occluding the aorta during endovascular repair of ruptured abdominal aortic aneurysms.
J Vasc Surg 2006; 44: 211

Here’s a link to the resus.me blog for a paper on balloon catheters used for other sites: Balloon catheters for haemorrhage control

This entry was posted in Emergency Medicine, Intensive Care, Tech, Trauma. Bookmark the permalink.

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