Resuscitative endovascular balloon occlusion of the aorta
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a recently developed treatment for hemorrhagic shock used in major trauma patients with life-threatening abdominal or lower limb bleeding.
The aortic balloon is delivered on a catheter via the femoral artery in order to reduce any distal bleeding and raise blood pressure in order to buy time for definitive surgical hemostasis. It has been used both in the pre-hospital and emergency room setting in a small number of trauma patients but high-quality data on its efficacy remains lacking 1.
Potentially used in selected adult patients aged 18-69 years with suspected of confirmed internal hemorrhage below the level of the diaphragm:
- in hemorrhagic shock unresponsive or transiently responsive to resuscitation
- in PEA arrest < 10 minutes
- age > 70 years
- pre-existing terminal illness or significant co-morbidity
- high suspicion of proximal traumatic aortic dissection
- groin vessels not immediately identifiable on ultrasound
- PEA arrest > 10 minutes
- cardiac arrest from other causes than exsanguination
- significant non-compressible hemorrhage above the diaphragm
- superior mediastinum
- face or neck
There is a reported 4-5% incidence of arterial puncture related complications from the procedure 3.
Mortality in these patients remains high at between 34-64% with a lack of high-quality data for the effectiveness of REBOA 4.
- 1. Emiliano Gamberini, Federico Coccolini, Beatrice Tamagnini, Costanza Martino, Vittorio Albarello, Marco Benni, Marcello Bisulli, Nicola Fabbri, Tal Martin Hörer, Luca Ansaloni, Carlo Coniglio, Marco Barozzi, Vanni Agnoletti. Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature. (2017) World Journal of Emergency Surgery. 12 (1): 42. doi:10.1186/s13017-017-0153-2 - Pubmed
- 2. Brenner M, Bulger EM, Perina DG, Henry S, Kang CS, Rotondo MF, Chang MC, Weireter LJ, Coburn M, Winchell RJ, Stewart RM. Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). (2018) Trauma surgery & acute care open. 3 (1): e000154. doi:10.1136/tsaco-2017-000154 - Pubmed
- 3. Manzano-Nunez R, Orlas CP, Herrera-Escobar JP, Galvagno S, DuBose J, Melendez JJ, Serna JJ, Salcedo A, Peña CA, Angamarca E, Horer T, Salazar CJ, Lopez-Castilla V, Ruiz-Yucuma J, Rodriguez F, Parra MW, Ordoñez CA. A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients. (2018) The journal of trauma and acute care surgery. doi:10.1097/TA.0000000000001978 - Pubmed
- 4. Emiliano Gamberini, Federico Coccolini, Beatrice Tamagnini, Costanza Martino, Vittorio Albarello, Marco Benni, Marcello Bisulli, Nicola Fabbri, Tal Martin Hörer, Luca Ansaloni, Carlo Coniglio, Marco Barozzi, Vanni Agnoletti. Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature. (2017) World Journal of Emergency Surgery. 12 (1): 42. doi:10.1186/s13017-017-0153-2 - Pubmed