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Principles of REBOA

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Endovascular Resuscitation and Trauma Management

Part of the book series: Hot Topics in Acute Care Surgery and Trauma ((HTACST))

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Abstract

Resuscitative endovascular balloon occlusion of aorta (REBOA) is a minimally invasive means of obtaining proximal aortic control in exsanguinating patients. Indications for its use continue to be investigated, but it has shown promise in management of subdiaphragmatic and pelvic hemorrhage in trauma, as well as management of hemorrhage in obstetric and oncologic procedures. The procedure is predicated upon rapidly obtaining femoral arterial access which can be challenging due to physiologic or physical characteristics of the patient. All phases of the procedure, access, sheath placement, balloon positioning, management while occluded, balloon deflation, and post-resuscitation care, present opportunities for unique potential complications and challenges in patient management. REBOA is a field ripe with ongoing research, with efforts chiefly aimed at safely expanding the duration of safe aortic occlusion and mitigation of complications.

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Author information

Authors and Affiliations

  1. Department of Surgical Critical Care, RA Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA

    Anna Romagnoli

  2. University of California Riverside School of Medicine, Riverside, CA, USA

    Megan Brenner

Authors
  1. Anna Romagnoli
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  2. Megan Brenner
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Corresponding author

Correspondence to Megan Brenner .

Editor information

Editors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden

    Tal Hörer

  2. University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Joseph J. DuBose

  3. F. Edward Hebert School of Medicine – “America’s Medical School”, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    Todd E. Rasmussen

  4. The Department of Surgery at Uniformed Services, University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD, USA

    Joseph M. White

Expert’s Comments by Catherine Arvieux

Expert’s Comments by Catherine Arvieux

The concept of endovascular hemorrhage control is not a new one; it was initially described in 1954 [15]. A recent technique, the resuscitative endovascular balloon occlusion of the aorta (REBOA), is being increasingly used as a noninvasive clamp of the aorta to stabilize patients’ hemodynamics until definitive hemostasis is achieved [38]. Depending on the location of hemorrhage, the aortic balloon can be inflated in two different aortic zones, namely, Zone 1 or III. It has become a salvage therapy in patients with both post-traumatic and non-trauma life-threatening hemorrhage [38]. As shown in this exhaustive documented chapter, REBOA is a swift and effective method for treating circulatory failure in patients, not only those with hemorrhagic shock from intra-abdominal or pelvic injuries and post-traumatic liver hemorrhage but also obstetric and gynecologic hemorrhage and complex pelvic oncologic procedures [38]. In hemodynamically unstable trauma patients, REBOA can be used as a temporizing measure to maintain coronary and cerebral perfusion proximally, and decrease hemorrhage distally, while awaiting definitive surgical or angiographic intervention, especially in the case of angiographics resources not being located within the site of admission. The main concern about the REBOA procedure is safety [38]. Several authors reported complications after REBOA such as groin access complications, lower limb ischemia, limb amputation, acute kidney failure, or rhabdomyolysis [63]. However, the incidence of REBOA-related complications appeared to be acceptable in the hands of experienced radio-interventional radiologists [64]. As shown in this chapter, ultrasound guidance and using a small-size sheath (7 Fr) has been proved to be associated with less vascular complications than larger diameter [38]. It has been described good results with REBOA performed at the bedside by trained acute care surgeons or intensivists, which may be very useful in the pre-hospital setting [58]. In the future, Partial-REBOA aims to decrease distal ischemia by allowing titrated, controlled, low-volume flow distal to aortic occlusion while maintaining physiologic carotid flow [60].

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Romagnoli, A., Brenner, M. (2020). Principles of REBOA. In: Hörer, T., DuBose, J., Rasmussen, T., White, J. (eds) Endovascular Resuscitation and Trauma Management . Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-030-25341-7_6

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  • DOI: https://doi.org/10.1007/978-3-030-25341-7_6

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