Aortic Balloon Occlusion for Exsanguinating Upper GI Bleeding

Uncommonly, patients with nonvariceal upper gastrointestinal bleeding (UGIB) present with massive blood loss and impending cardiovascular collapse. In these situations, standard therapy may be logistically or technically impossible.

Investigators at a single hospital in Japan retrospectively reviewed outcomes in eight patients (all men; mean age, 66 years) with UGIB and hemorrhagic shock who did not respond to vigorous volume resuscitation. Patients were treated in the emergency department or intensive care unit with resuscitative endovascular balloon occlusion of the aorta (REBOA), a technique that has been used in trauma patients to support central blood pressure while hemostasis is achieved. Results were as follows:

• Systolic blood pressure increased from a mean of 66 to 117 mmHg (P<0.01) after REBOA.

• Endoscopic hemostasis was subsequently achieved in three patients, and the other five had successful arterial embolization (three after failed endoscopic therapy).

• Balloon placement failed in one patient. That patient and another patient with a duodenal ulcer died in the first 24 hours. The remainder survived beyond 30 days. No complications from the balloon occurred.

• The mean REBOA occlusion time was 80 ± 48 minutes.

• A higher serum lactate level, higher clinical Rockall score, and older age were correlated with longer occlusion time.