1Talal Mourad,2Usman Mahay
1University of Illinois College of Medicine Peoria, 2University Hospitals Birmingham NHS Foundation Trust
1. Provide a review of resuscitative endovascular balloon occlusion of the aorta (REBOA) and explore its utility in controlling non-compressible hemorrhage below the diaphragm. 2. Discuss the clinical indications for REBOA as well as contraindications and recognized complications. 3. Outline steps for REBOA placement with helpful illustrations.
Material(s) and Method(s):
REBOA is an intervention that can control life-threatening hemorrhage below the diaphragm for patients in hemorrhagic shock unresponsive to resuscitation. It is a temporary measure intended to sustain perfusion to the heart and brain until definitive hemorrhage control can be obtained. It has gained popularity as a minimally invasive alternative to resuscitative thoracotomy (RT) with aortic cross-clamping, which has been the standard in controlling non-compressible torso hemorrhage. However, careful clinical evaluation is warranted prior to REBOA placement. Only patients meeting appropriate criteria are candidates for therapy. This criteria, as well as contraindications and complications from REBOA use will be discussed in detail.
Vascular access is usually obtained through the common femoral artery with a 7 French sheath and a balloon is directed either to Zone 1 (between the left subclavian and celiac arteries) or Zone 3 (between the caudal renal artery and aortic bifurcation) of the aorta. While Zone 1 occlusion is indicated for confirmed hemorrhage arising below the diaphragm, Zone 3 occlusion is reserved for patients in hemorrhagic shock with evidence of a pelvic fracture. Once the appropriate balloon location is confirmed on imaging, the balloon is inflated to tamponade the vessel. Monitoring for loss of the contralateral femoral pulse indicates sufficient balloon inflation. The patient may then be transferred for definitive surgical or endovascular hemorrhage control.
REBOA is a recognized safe and efficacious intervention for rapid, non-invasive control of non-compressible hemorrhage in an emergency setting. It has been shown to be a faster method to aortic occlusion compared with RT after obtaining arterial access. Ongoing research should elucidate further clinical indications and outcomes regarding its use.