Resuscitative endovascular balloon occlusion of the aorta

Last revised by Rohit Sharma on 6 Apr 2024

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a 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:

  • 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

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.

Generally two zones are used for temporary aortic occlusion:

  • zone one: above the celiac axis, the ideal position for suspected active abdominal bleeding

  • zone three: below the lowest renal artery, typically used in case of pelvic trauma

  • zone two: lies between the above two zones, should not be used as it endangers mesenteric and renal circulation

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