{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T23:00:33Z","timestamp":1793055633595,"version":"4.5.0"},"reference-count":26,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T00:00:00Z","timestamp":1628812800000},"content-version":"unspecified","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2021,7,26]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Patients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective case\u2013control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of \u22654 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received \u22654 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Decrease in blood transfusions of \u22654 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of evidence<\/jats:title>\n                  <jats:p>IV.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2021-000750","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T12:56:13Z","timestamp":1628859373000},"page":"e000750","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1531-2894","authenticated-orcid":false,"given":"Yevgeniya J M","family":"Ioffe","sequence":"first","affiliation":[{"name":"Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrid","family":"Burruss","sequence":"additional","affiliation":[{"name":"Department of Surgery, Divisions of Acute Care Surgery and Critical Care, Loma Linda University Medical Center, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruofan","family":"Yao","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics, Division of Maternal Fetal Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly","family":"Tse","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia","family":"Cryer","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaushik","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Surgery, Divisions of Acute Care Surgery and Critical Care, Loma Linda University Medical Center, Loma Linda, California, USA"},{"name":"Loma Linda University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda J","family":"Hong","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,8,13]]},"reference":[{"key":"2025082410395732000_6.1.e000750.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(99)00396-8"},{"key":"2025082410395732000_6.1.e000750.2","doi-asserted-by":"crossref","first-page":"e259","DOI":"10.1097\/AOG.0000000000002983","article-title":"Obstetric care consensus No. 7: placenta accreta spectrum","volume":"132","year":"2018","journal-title":"Obstet Gynecol"},{"key":"2025082410395732000_6.1.e000750.3","doi-asserted-by":"crossref","first-page":"632.e1","DOI":"10.1016\/j.ajog.2009.02.001","article-title":"Changing trends in Peripartum hysterectomy over the last 4 decades","volume":"200","author":"Flood","year":"2009","journal-title":"Am J Obstet Gynecol"},{"key":"2025082410395732000_6.1.e000750.4","doi-asserted-by":"crossref","first-page":"38.e1","DOI":"10.1016\/j.ajog.2011.01.040","article-title":"Predictors of massive blood loss in women with placenta accreta","volume":"205","author":"Wright","year":"2011","journal-title":"Am J Obstet Gynecol"},{"key":"2025082410395732000_6.1.e000750.5","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.ogc.2015.01.014","article-title":"Placenta accreta spectrum: accreta, increta, and percreta","volume":"42","author":"Silver","year":"2015","journal-title":"Obstet Gynecol Clin North Am"},{"key":"2025082410395732000_6.1.e000750.6","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1055\/s-0038-1641736","article-title":"Pilot study of intra-aortic balloon occlusion to limit morbidity in patients with adherent placentation undergoing cesarean hysterectomy","volume":"8","author":"Blumenthal","year":"2018","journal-title":"AJP Rep"},{"key":"2025082410395732000_6.1.e000750.7","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/S1028-4559(10)60013-7","article-title":"Temporary cross-clamping of the infrarenal abdominal aorta during cesarean hysterectomy to control operative blood loss in placenta previa increta\/percreta","volume":"49","author":"Chou","year":"2010","journal-title":"Taiwan J Obstet Gynecol"},{"key":"2025082410395732000_6.1.e000750.8","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1479-828X.2004.00181.x","article-title":"Balloon occlusion of the descending aorta in the treatment of severe post-partum haemorrhage","volume":"44","author":"Harma","year":"2004","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"2025082410395732000_6.1.e000750.9","doi-asserted-by":"crossref","first-page":"470.e1","DOI":"10.1016\/j.ajog.2007.05.017","article-title":"Prophylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case","volume":"197","author":"Greenberg","year":"2007","journal-title":"Am J Obstet Gynecol"},{"key":"2025082410395732000_6.1.e000750.10","first-page":"65","article-title":"Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man","volume":"36","author":"Hughes","year":"1954","journal-title":"Surgery"},{"key":"2025082410395732000_6.1.e000750.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2011.06.010"},{"key":"2025082410395732000_6.1.e000750.12","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001079"},{"key":"2025082410395732000_6.1.e000750.13","unstructured":"Food and Drug Administration . ER-REBOA Catheter approval letter. 2017. https:\/\/www.accessdata.fda.gov\/cdrh_docs\/pdf17\/K170411.pdf."},{"key":"2025082410395732000_6.1.e000750.14","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31823fe90c"},{"key":"2025082410395732000_6.1.e000750.15","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1093\/ejcts\/ezaa313","article-title":"Clinical cases referring to current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"59","author":"Czerny","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"2025082410395732000_6.1.e000750.16","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1007\/s00068-018-0973-0","article-title":"Resuscitative endovascular balloon occlusion of the aorta for non-traumatic intra-abdominal hemorrhage","volume":"45","author":"Hoehn","year":"2019","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410395732000_6.1.e000750.17","first-page":"942","article-title":"Intra-Aortic balloon occlusion to salvage patients with life-threatening hemorrhagic shocks from pelvic fractures","volume":"68","author":"Martinelli","year":"2010","journal-title":"J Trauma"},{"key":"2025082410395732000_6.1.e000750.18","doi-asserted-by":"crossref","first-page":"520","DOI":"10.4103\/ija.IJA_121_20","article-title":"The management of patients with placenta percreta: a case series comparing the use of resuscitative endovascular balloon occlusion of the aorta with aortic cross clamp","volume":"64","author":"Stubbs","year":"2020","journal-title":"Indian J Anaesth"},{"key":"2025082410395732000_6.1.e000750.19","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.ijoa.2015.12.001","article-title":"Prophylactic abdominal aorta balloon occlusion during caesarean section: a retrospective case series","volume":"27","author":"Wei","year":"2016","journal-title":"Int J Obstet Anesth"},{"key":"2025082410395732000_6.1.e000750.20","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s00068-017-0840-4","article-title":"Expanding the field of acute care surgery: a systematic review of the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in cases of morbidly adherent placenta","volume":"44","author":"Manzano-Nunez","year":"2018","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410395732000_6.1.e000750.21","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1097\/TA.0000000000001821","article-title":"Prophylactic use of resuscitative endovascular balloon occlusion of the aorta in women with abnormal placentation: a systematic review, meta-analysis, and case series","volume":"84","author":"Ordo\u00f1ez","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025082410395732000_6.1.e000750.22","first-page":"1","article-title":"Risk of vascular complications in prophylactic compared to emergent resuscitative endovascular balloon occlusion of the aorta (REBOA) in the management of placenta accreta spectrum","author":"Whittington","year":"2020","journal-title":"J Matern Fetal Neonatal Med"},{"key":"2025082410395732000_6.1.e000750.23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0174520"},{"key":"2025082410395732000_6.1.e000750.24","article-title":"A new method using surface landmarks to locate resuscitative endovascular balloon occlusion of the aorta based on a retrospective cta study","author":"Weng","year":"2021","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2025082410395732000_6.1.e000750.25","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.amjsurg.2019.04.019","article-title":"Catheter distances and balloon inflation volumes for the ER-REBOA\u2122 catheter: a prospective analysis","volume":"219","author":"Meyer","year":"2020","journal-title":"Am J Surg"},{"key":"2025082410395732000_6.1.e000750.26","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.1007\/s00270-016-1418-y","article-title":"Outcome of pregnancies after balloon occlusion of the infrarenal abdominal aorta during caesarean in 230 patients with placenta praevia accreta","volume":"39","author":"Wu","year":"2016","journal-title":"Cardiovasc Intervent Radiol"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2021-000750","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T17:40:13Z","timestamp":1756057213000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2021-000750"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,8,13]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/tsaco-2021-000750"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2021-000750","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}