The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been a hot topic on the cutting edge of trauma resuscitation for several years now. But who should be doing this procedure, on whom, and when? Tissue ischemia results from REBOA followed by reperfusion injury, organ dysfunction and potential cardiovascular collapse. Although appropriate patient selection is paramount, the system of care that surrounds this procedure is vital to minimizing delays to definitive hemorrhage control as well as the ischemic insult of aortic occlusion.
In 2018, the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) published a joint statement on the clinical use of REBOA2. This statement was met with much criticism from the emergency medicine/critical care world. Due to this, a revised statement has been published with different recommendations1. So, what does this statement say and how is it different from the 2018 statement?...Read More
The management of the critically hemorrhaging trauma patient has seen a large amount of change over last decade, from bringing care far forward to the field to early use of blood products to civilian translation and application tourniquets to name a few.
The reality unfortunately is that there is still a subgroup of patients who continue to suffer early mortality from hemorrhage, primarily because they are bleeding in the torso. This is particularly challenging for both prehospital and in-hospital clinicians to manage as these areas do not allow control through direct compression.
Enter resuscitative endovascular balloon occlusion of the aorta (REBOA) – a technique that builds on principles from vascular surgery and sees the placement of a balloon catheter into the aorta via the femoral artery. Acting as an internal tourniquet, it temporarily occludes flow to the bleeding vessel thus providing circulatory support and precious time to get the patient to definitive care.
With the alternative being death from hemorrhage, REBOA came as a breath of fresh air – a minimally invasive means of achieving hemorrhage control in these extremely sick patients. There were innovators and early adopters and reports of fantastic saves – patients were surviving who would never have survived before. ...Read More