Partial resuscitative endovascular balloon occlusion of the aorta as a hemorrhagic shock adjunct for ectopic pregnancy

摘要

Intractable hemorrhage is a main cause of death in the emergency department (ED). Acute care physicians also encounter various causes of life-threatening hemorrhagic shock, including trauma, ruptured abdominal aortic aneurysms, and postpartum bleeding secondary to placenta previa or placenta abruption. In a recent systematic review, resuscitative endovascular balloon occlusion of the aorta (REBOA) in various clinical settings was found to successfully elevate central blood pressure and control hemodynamic status as an adjunct for surgical hemostasis in life-threatening hemorrhagic shock. However, there are no published reports describing the use of REBOA to control the hemorrhagic status for patients with hemodynamic shock caused by an ectopic pregnancy. Recently, partial REBOA with a halfway balloon inflation increased survival time to 180 minutes, maintaining the central blood pressure and carotid blood flow. In this study, we treated a patient with hemorrhagic shock caused by a ruptured ectopic pregnancy who underwent an intraaortic balloon occlusion device deployment in the ED and successful surgical hemostasis assisted with partial REBOA. We concluded that alternative and aggressive use of partial REBOA is effective among patients with hemorrhagic shock caused by an obstetrical disease.