title: A decade's experience with balloon catheter tamponade for the emergency control of hemorrhage.
abstract: BACKGROUND
  Balloon catheter tamponade is a valuable technique for arresting exsanguinating hemorrhage. Indications include (1) inaccessible major vascular injuries, (2) large cardiac injuries, and (3) deep solid organ parenchymal bleeding. Published literature is limited to small case series. The primary goal was to review a recent experience with balloon catheter use for emergency tamponade in a civilian trauma population.
  
  
  METHODS
  All patients requiring emergency use of a balloon catheter to tamponade exsanguinating hemorrhage (1998-2009) were included. Patient demographics, injury characteristics, technique, and outcomes were analyzed.
  
  
  RESULTS
  Of the 44 severely injured patients (82% presented with hemodynamic instability; mean base deficit=-20.4) who required balloon catheter tamponade, 23 of the balloons (52%) remained indwelling for more than 6 hours. Overall mortality depended on the site of injury/catheter placement and indwelling time (81% if <6 hours; 52% if ≥6 hours; p<0.05). Physiologic exhaustion was responsible for 76% of deaths in patients with short-term balloons. Mortality among patients with prolonged balloon catheter placement was 11%, 50%, and 88% for liver, abdominal vascular, and facial/pharyngeal injuries, respectively. Mean indwelling times for iliac, liver, and carotid injuries were 31 hours, 53 hours, and 78 hours, respectively. Overall survival rates were 67% (liver), 67% (extremity vascular), 50% (abdominal vascular), 38% (cardiac), and 8% (face). Techniques included Foley, Fogarty, Blakemore, and/or Penrose drains with concurrent red rubber Robinson catheters. Initial tamponade of bleeding structures was successful in 93% of patients.
  
  
  CONCLUSIONS
  Balloon catheter tamponade can be used in multiple anatomic regions and for variable patterns of injury to arrest ongoing hemorrhage. Placement for central hepatic gunshot wounds is particularly useful. This technique remains a valuable tool in a surgeon's armamentarium.
authors.affiliation: Department of Surgery, Emory University, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Amy D
authors.initials: AD
authors.lastname: Wyrzykowski
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Nicholas
authors.forename: Grace S
authors.initials: GS
authors.lastname: Rozycki
authors.forename: David V
authors.initials: DV
authors.lastname: Feliciano
mesh_terms: D000328:Adult; D021721:Balloon Occlusion / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D058734:Exsanguination / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000628:therapy