(836) Selective aortic balloon occlusion in Placenta Accreta Spectrum: retrospective review of utilization and outcomes

Aortic balloon occlusion (ABO) has been used to control hemorrhage in trauma and placenta accreta spectrum (PAS) surgery.  However, ABO is associated with cost and resource allocation and unique risks including vascular injury, thrombosis, and requires trained providers for use and management of complications.  We shifted from universal to selective ABO access following 3 cases of VTE with a 7Fr ABO in 2019.  We aimed to describe contemporary ABO use within a multidisciplinary PAS center, based on suspected disease severity, intraoperative findings and active hemorrhage.

Study Design:

Retrospective study of all PAS patients between Jan 2020-July 2022 at a single center.  Patients were grouped as ABO deployed, sheath only and control (no sheath/no ABO).  Charts were abstracted by a single reviewer and validated by a PAS expert.   Demographics, FIGO clinical PAS grade, blood loss, units transfused, nadir of H/H, coagulation profiles and maternal outcomes (Table) were compared between group using Chi-squared tests and Two-way ANOVA with multiple comparisons (GraphPad Prism 9.4.1, P< 0.05 = significant).

Results:

60 patients with confirmed PAS delivered during the study period, in whom 12 (20%) had femoral artery access with a 4Fr arterial cannula.  ABO (4Fr or 7Fr) was deployed when excess bleeding was encountered in 5 cases (8.3%).  One required emergent ABO following manual aortic compression. No maternal deaths, vascular complications or venous thrombotic events occurred in the cohort.  Blood loss and rate of red blood cell (RBC) transfusion was higher in the ABO-deployed group, as was FIGO Clinical Grade.  Blood loss and transfusion rates did not differ significantly between sheath only and control groups (Table).

Conclusion:

Our data support selective ABO deployment prophylactically for extensive PAS cases or therapeutically for ongoing, uncontrolled  hemorrhage as a pragmatic approach to balance the risks of massive hemorrhage with the risks and cost of femoral artery access and aortic balloon occlusion.