Uterine rupture successfully treated with a damage-control strategy of hysterectomy and resuscitative endovascular balloon occlusion of the aorta-assisted cardiopulmonary resuscitation

Yutaro Okamoto; Kenichiro Ishida; Yosuke Matsumura; Yoshiaki Yoshikawa; Taku Sogabe; Yusuke Fujikami; Kenji Ban; Keiji Tatsumi; Mitsuo Ohnishi

doi:10.1002/ams2.881

Uterine rupture successfully treated with a damage-control strategy of hysterectomy and resuscitative endovascular balloon occlusion of the aorta-assisted cardiopulmonary resuscitation

Acute Med Surg. 2023 Aug 3;10(1):e881. doi: 10.1002/ams2.881. eCollection 2023 Jan-Dec.

Authors

Yutaro Okamoto¹, Kenichiro Ishida¹, Yosuke Matsumura², Yoshiaki Yoshikawa¹, Taku Sogabe¹, Yusuke Fujikami³, Kenji Ban³, Keiji Tatsumi³, Mitsuo Ohnishi¹

Affiliations

¹ Department of Acute Medicine and Critical Care Medical Center Osaka National Hospital, National Hospital Organization Osaka Japan.
² Department of Intensive Care Chiba Emergency Medical Center Chiba Japan.
³ Department of Obstetrics and Gynecology Osaka National Hospital, National Hospital Organization Osaka Japan.

Abstract

Background: Uterine rupture is a major cause of postpartum hemorrhage (PPH) that requires surgery. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is also helpful for PPH. However, the effectiveness of REBOA in PPH with cardiac arrest is unknown.

Case presentation: A 40-year-old woman developed hemorrhagic shock due to uterine rupture after an induced delivery. She developed cardiac arrest, but was rescued by cardiopulmonary resuscitation (CPR), REBOA, a hysterectomy, and pelvic gauze packing. The hemodynamics were too unstable to move to the operating room. Then we initiated the CPR assisted with REBOA and decided to activate massive transfusion and perform laparotomy in the emergency room. She was finally discharged home without neurological sequelae.

Conclusion: Our damage control strategy, including REBOA-assisted CPR, contributed to saving the life of a patient with a life-threatening PPH.

Keywords: damage control; disseminated intravascular coagulation; postpartum hemorrhage; resuscitative endovascular balloon occlusion of the aorta; uterine rupture.

Publication types

Case Reports