Place the Sheath: Emergent 7 French Femoral Sheath Placement is Low Risk During Initial Trauma Resuscitation

• Published in: Journal of Endovascular Resuscitation and Trauma Management 2023-01, Vol.6 (3), p.127-133
• Main Authors: Cralley, Alexis L, DeBot, Margot, Hadley, Jamie, Pieracci, Fredric, Platnick, Barry K, Campion, Eric, Moore, Ernest E, Cohen, Mitchell J, Fox, Charles J, Lawless, Ryan A
• Format: Article
• Language: English
• Subjects: Emergent Common Femoral Artery Access; Endovascular Resuscitation Complications; Resuscitative Endovascular Balloon Occlusion of the Aorta; Trauma Resuscitation
• ISSN: 2003-539X; 2002-7567; 2003-539X
• DOI: 10.26676/jevtm.269

Background: We hypothesized that emergent placement of 7 French (Fr) common femoral artery (CFA) sheaths during trauma resuscitation for potential resuscitative endovascular balloon occlusion of the aorta (REBOA) carries a low complication rate. Methods: Trauma patients at a Level I trauma center with emergent CFA access from January 2016 through to December 2020 were reviewed. CFA access was categorized as (1) 7 Fr sheath plus REBOA (REBOA) and (2) 7 Fr sheathwithout REBOA (Sheath). Outcomes included mortality and vascular complications.  Results: 157 patients underwent emergent CFA access. Sixty-nine (43.9%) patients had a 7 Fr CFA sheath, and 88 (56.1%) progressed to REBOA. The mortality rate was similar (Sheath 30.4% vs. REBOA 34.1%, p = 0.63). The REBOA cohort had a significantly higher complication rate (22.7%) compared to the Sheath cohort (4.3%, p = 0.001). Conclusions: Emergent 7 Fr CFA sheath placement during trauma resuscitation is low risk, suggesting empiric sheath placement is warranted in potential REBOA candidates.