Emergency Medicine Book

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Resuscitative Endovascular Balloon Occlusion of the Aorta

Aka: Resuscitative Endovascular Balloon Occlusion of the Aorta, REBOA
  1. Indications
    1. Does not replace resuscitative thoracotomy
      1. REBOA is an adjunct that reduces subdiaphragmatic Hemorrhage
      2. Chest Hemorrhage is a relative contraindication to REBOA as it would likely increase chest bleeding
    2. Severe Pelvic Fractures who have not had Cardiac Arrest who need immediate temporizing measures
      1. May be considered in Peri-Arrest patient without obvious source of Hemorrhage
      2. Best used for short-term bridging to definitive procedure (risk of distal ischemia)
  2. Technique
    1. Performed in 5-10 minutes in skilled hands
    2. Catheter insertion length determined prior to insertion (mark stop point)
    3. Percutaneous balloon delivered via femoral catheter and inflated in aorta above level of Hemorrhage
      1. Zone 1: Subdiaphragmatic (typical target for balloon placement)
      2. Zone 3: Iliac Bifurcation
  3. Efficacy
    1. Efficacy is difficult to measure for a last-ditch effort to stave off death for minutes to allow for emergent surgery
    2. Studies in 2016, suggest lower efficacy than initially thought, and may be associated with higher mortality
      1. Inoue (2016) J Trauma Acute Care Surg 80(4): 559-67 +PMID: 26808039 [PubMed]
  4. Complications
    1. Aortic Dissection
    2. Suprarenal Occlusion (balloon too high)
    3. Distal Thromboembolism
  5. Resources
    1. HQMedEd (Glenn Paetow)
      1. http://hqmeded.com/resuscitative-endovascular-balloon-occlusion-aorta-reboa/
  6. References
    1. Inaba in Herbert (2013) EM:Rap 13(11): 3-4
    2. Shoenberger, Swadron and Inaba in Herbert (2018) 18(12): 10-11
    3. Hughes (1954) Surgery 36(1):65-8 [PubMed]

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