EMOttawa - Emergency Medicine Ottawa

The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has become a topic of considerable interest as of late, primarily to treat non-compressible truncal hemorrhage (NCTH). However, it is beginning to expand into other causes of non-compressible bleeding.  Why do we care? Bleeding is the 2nd leading cause of traumatic death behind only traumatic brain injury (TBI). Additionally, it is the number one cause of preventable death in trauma, causing 85% of all preventable trauma deaths.  Furthermore, 35% of all pre-hospital deaths and over 40% of deaths within the first 24 hours following trauma are attributed to bleeding (Kauvar, Lefering, & Wade, 2006).  One article states that there are around 60 000 civilian deaths per year in the US secondary to traumatic bleeding (Sauaia et al., 1995). Is this REBOA thing new?! Nope. 
The concept and use of REBOA has been around since at least 1954, when Lieutenant Colonel Carl Hughes of the US military published an article desc…

This is a summary of a talk given by Drs. Krishan Yadav and Maggie Kisilewicz at the National Capital Conference in Emergency Medicine. Below are brief summaries and a bottom line, but of course you'll have to read the literature yourself to make your own decisions! 1) Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage ATACH-2  Qureshi et al. N Engl J Med 2016; 375: 1033 – 1043.
DOI: 10.1056/NEJMoa1603460.

• RCT to assess if aggressive SBP reduction within 4.5 hours of spontaneous intracranial hemorrhage results in decreased death or disability at 3 months.
• Main Finding: No difference in death or disability at 3 months for Intensive BP (110 – 139 mmHg) vs. Standard BP (140 – 179 mmHg) group.
o Caution: this trial really compared SBP targets of 129 mmHg vs. 141 mmHg (see Figure 1)
• Bottom Line: BP reduction to 140 mmHg is safe. Aim for a SBP target of 160 mmHg in  spontaneous ICH – if the patient continues to deteriorate, revise target to 140 mmHg.

2) …

Methodology: 3/5           Usefulness: 3/5 Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, Lee HS, Ahn S, Kim T, Hwang SS, Song KJ, Kang SB, Kim DW, Park SH, Lee KH. N Engl J Med. 2012 Apr 26;366(17):1596-605
Article Link
This single-centre randomized non-inferiority trial found that low-dose abdominal CT was non-inferior to standard dose in terms of negative appendectomy rates with an absolute increase of 0.3% in the low dose group (0.3, 95% confidence interval -3.8 to 4.6). The group felt this was not a practice changing study, as it did not include obese patients; there was a high risk of bias as the interpreting radiologists were not blinded, and it was not applicable to our clinical practice in Canada where we often obtain an ultrasound before CT.  By: Dr. Hanzla Tariq (Presented January 2013)
Epi Lesson: Non-inferiority trials are distinct from superiority trials such that they are designed to determine whether a given intervention is non-inferior by a pre-specified margin compared to a co…