Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

REBOA was developed to address the challenge of managing non-compressible torso haemorrhage, a major cause of potentially preventable death after traumatic injury.  It involves placement of an endovascular balloon in the aorta to control haemorrhage and to augment afterload in traumatic arrest and haemorrhagic shock states.  REBOA is not without significant risk. Occlusion of the aorta results in tissue ischemia followed by reperfusion injury, predisposing to organ dysfunction and cardiovascular collapse.  A 2015 study¹ found an association between use of REBOA and excess mortality in patients with haemodynamically unstable torso trauma.

There is no high-grade evidence demonstrating that REBOA improves outcomes or survival compared with standard treatment of severe traumatic hemorrhage.²  REBOA does not confer any long-term survival advantage when used in traumatic cardiac arrest compared with standard of care.³

Though it remains unclear if there is are any valid indications for its use, some suggest REBOA may be better suited to prehospital/ remote settings lacking immediate access to definitive surgical therapy.

 

 

References

 

1. Inoue J, Shiraishi A, Yoshiyuki A, Haruta K, Matsui H, Otomo Y. Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: a propensity score analysis. J Trauma Acute Care Surg 2016;80:559–67.
2. Joseph B, Zeeshan M, Sakran JV, Hamidi M, Kulvatunyou N, Khan M, O’Keeffe T, Rhee P. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg2019;154:500 10.1001/jamasurg.2019.0096
3. Brenner M, Inaba K, Aiolfi A, DuBose J, Fabian T, Bee T, Holcomb JB, Moore L, Skarupa D, Scalea TM, et al. . Resuscitative Endovascular Balloon Occlusion of the Aorta and Resuscitative Thoracotomy in Select Patients with Hemorrhagic Shock: Early Results from the American Association for the Surgery of Trauma’s Aortic Occlusion in Resuscitation for Trauma and Acute Care Surgery Registry. J Am Coll Surg2018;226:730–40. 10.1016/j.jamcollsurg.2018.01.044