Successful Utilization of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient.

In the United States, pediatric trauma resulting in traumatic brain injury (TBI) and massive hemorrhage is the leading cause of death. Although use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) continues to gain favor, limited data exists on use and efficacy in pediatric patients. We describe a case using REBOA in a pediatric patient with blunt abdominal injury causing hemorrhagic shock. A 14-year-old female presented via air to a level 1 trauma center post motor vehicle collision with prolonged extraction. At landing, she was hemodynamically unstable with GCS and vitals indicating severe injuries. Further assessment indicated REBOA catheter placement with advancement to zone 1. Upon surgical stabilization, REBOA was deflated and distal pulses were maintained without complication. In cases where massive hemorrhage is the major threat to survival, REBOA may improve outcomes. Unfortunately, this patient had sustained a nonsurvivable TBI, and the family decided upon organ donation.

End-tidal carbon dioxide underestimates plasma carbon dioxide during emergent trauma laparotomy leading to hypoventilation and misguided resuscitation: A Western Trauma Association Multicenter Study.

BACKGROUND: End-tidal carbon dioxide (ETCO2) is routinely used during elective surgery to monitor ventilation. The role of ETCO2 monitoring in emergent trauma operations is poorly understood. We hypothesized that ETCO2 values underestimate plasma carbon dioxide (pCO2) values during resuscitation for hemorrhagic shock. METHODS: Multicenter trial was performed analyzing the correlation between ETCO2 and pCO2 levels. RESULTS: Two hundred fifty-six patients resulted in 587 matched pairs of ETCO2 and pCO2. Correlation between these two values was very poor with an R of 0.04. 40.2% of patients presented to the operating room acidotic and hypercarbic with a pH less than 7.30 and a pCO2 greater than 45 mm Hg. Correlation was worse in patients that were either acidotic or hypercarbic. Forty-five percent of patients have a difference greater than 10 mm Hg between ETCO2 and pCO2. A pH less than 7.30 was predictive of an ETCO2 to pCO2 difference greater than 10 mm Hg. A difference greater than 10 mm Hg was predictive of mortality independent of confounders. CONCLUSION: Nearly one half (45%) of patients were found to have an ETCO2 level greater than 10 mm Hg discordant from their PCO2 level. Reliance on the discordant values may have contributed to the 40% of patients in the operating room that were both acidotic and hypercarbic. Early blood gas analysis is warranted, and a lower early goal of ETCO2 should be considered. LEVEL OF EVIDENCE: Therapeutic, level IV.