Use of REBOA As an Adjunct to The Conventional Femoral Cut-Down For Bleeding Control During Veno-Arterial ECMO Decannulation

Öz

Introduction One of the potential complications of Extracorporeal Life Support is the arterial bleeding during decannulation. We present a case that describes the use of REBOA for hemorrhage control during femoral decannulation. Case Report 42-old-male who was suffering from ARDS and cardiogenic shock was admitted to the Intensive Care Unit and Veno-arterial (VA) ECMO was commenced. On day 4, his cardiac performance improved and we decided that there was no longer a need for cardiac support with ECMO. Thus, a conversion from VA to Veno-venous (VV) ECMO was planned. An additional venous cannula was placed and the arterial cannula in the femoral artery was withdrawn and the femoral artery wall was repaired just after a Zone III total REBOA was achieved from the contralateral femoral artery. There were not any significant changes in blood pressure, heart rate, and lactate levels before and after the procedure. Conclusion REBOA might be a useful tool in the hands of non-vascular surgeons to avoid unintended bleeding during the decannulation of a large-bore arterial cannulae.

Anahtar Kelimeler

• REBOA,Extracorporeal Membrane Oxygenation,decannulation,bleeding control

Kaynakça

1. 1) DuBose JJ, Scalea TM, Brenner M, et al. The AAST prospective aortic occlusion for resuscitation in trauma and acute care surgery (AORTA) registry: data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016; 81:409–19. 10.1097/TA.0000000000001079
2. 2) Özlüer YE, Yetis Ç, Sayın E, Avcil M. Succesful control of massive vaginal bleeding with resuscitative endovascular balloon occlusion of the aorta and pelvic packing. Journal of Endovascular Resuscitation and Trauma Management, [S.l.], v. 3, n. 3, sep. 2019. ISSN 2002-7567.
3. 3) Stensaeth KH, Sovik E, Haig INY, Skomedal E, Jorgensen A. Fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta (REBOA) for controlling life-threatening postpartum hemorrhage. PLoS One. 2017;12: e174520
4. 4) Ologun G, Sharpton K, Granet P. Successful use of resuscitative endovascular balloon occlusion of the aorta in the treatment of ruptured 8.5-cm splenic artery aneurysm. J Vasc Surg 2017; 66:1873–5. 10.1016/j.jvs.2017.05.138
5. 5) Xie A, Phan K, Tsai YC, YanTD, Forrest P. Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth 2015;29(03):637–645
6. 6) Guenther SP, Brunner S, Born F, et al. When all else fails: extracorporeal life support in therapy-refractory cardiogenic shock. Eur J Cardiothorac Surg 2016;49(03):802–809
7. 7) Clark JB, Wang S, Palanzo DA, et al. Current techniques and outcomes in extracorporeal life support. Artif Organs 2015;39 (11):926–930
8. 8) Majunke N, Mangner N, Linke A, et al: Comparison of percutaneous closure versus surgical femoral cutdown for decannulation of large-sized arterial and venous access sites in adults after successful weaning of venoarterial extracorporeal membrane oxygenation. J Invasive Cardiol 2016; 28:415–419

9. 9) Schmidt GA, editor. Extracorporeal life support for adults. New York: Springer New York; 2016.
10. 10) Bisdas T, Beutel G, Warnecke G. Vascular complications in patients undergoing femoral cannulation for extracorporeal membrane oxygenation support. Ann Thorac Surg. 2011; 92:626-631
11. 11) Aziz F, Brehm CE, El-Banyosy A, Han DC, Atnip RG, Reed AB. Arterial complications in patients undergoing extracorporeal membrane oxygenation via femoral cannulation. Ann Vasc Surg. 2014; 28:178-183
12. 12) Hwang JW, Yang JH, Sung K, et al: Percutaneous removal using perclose ProGlide closure devices versus surgical removal for weaning after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. J.Vasc Surg 2016; 63:998–1003.e1