Podcast #258: REBOA

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).

Exsanguination is a major cause of mortality in trauma

One temporizing technique to buy time to definitive hemorrhage control is to occlude the aorta thereby shunting blood away from pelvis and lower extremities, increasing cardiac afterload to increase myocardial and brain perfusion.

Rather than perform a thoracotomy to cross clamp aorta, a REBOA catheter may be introduced into the aorta via the common femoral artery and a balloon inflated in the descending aorta to occlude it.

The indications for REBOA include PEA arrest of brief duration attributable to exsanguination for sub-diaphragmatic source in a young, healthy patient, or severe hypovolemic shock or those in an agonal state due to non-compressible hemorrhage not responding to volume and in whom obstructive cause of shock has been ruled out.

Contraindicated in prolonged arrest, suspected proximal aortic injury, advanced age/comorbidities.

Controversies and evidence:

High quality evidence is lacking - as it is for much of what we do and even consider standard of care in trauma. It has not been shown to improve survival, which is hard to demonstrate.
Role in remote settings vs trauma centers unclear.
Further refinements of indication for use are likely to occur with time and experience.

Summarize - REBOA is a promising relatively new technology that may have potential to improve outcomes in the sickest of trauma patients.