Resuscitative Endovascular Balloon Occlusion of the Aorta: A Review for Emergency Clinicians

Brit Long, Lee Hafen, Alexander Koyfman, Michael Gottlieb

Research output: Contribution to journalArticle

Abstract

Background: Non-compressible torso hemorrhage (NCTH) is difficult to control and associated with significant mortality. Resuscitative endovascular balloon occlusion of the aorta (REBOA) utilizes an infra-diaphragmatic approach to control NCTH and is less invasive than resuscitative thoracotomy (RT). This article highlights the evidence for REBOA and provides an overview of the indications, procedural steps, and complications in adults for emergency clinicians. Discussion: Traumatic hemorrhage can be life threatening. Patients in extremis, whether from NCTH or exsanguination from other sites, may require RT with aortic cross-clamping. REBOA offers another avenue for proximal hemorrhage control and can be completed by emergency clinicians. The American College of Surgeons Committee on Trauma and the American College of Emergency Physicians recently released a joint statement detailing the indications for REBOA in adults. The evidence behind its use remains controversial, with significant heterogeneity among studies. Most studies demonstrate improved blood pressure without a significant improvement in mortality. Procedural steps include arterial access (most commonly the common femoral artery), positioning the initial sheath, balloon preparation and positioning, balloon inflation, securing the balloon/sheath, subsequent hemorrhage control, balloon deflation, and balloon/sheath removal. Several major complications can occur with REBOA placement. Future studies should evaluate training protocols, the role of simulation, and which target populations would benefit most from REBOA. Conclusions: REBOA can provide proximal hemorrhage control and can be performed by emergency clinicians. This article evaluates the evidence, indications, procedure, and complications for emergency clinicians.

Original languageEnglish (US)
JournalJournal of Emergency Medicine
DOIs
StatePublished - Jan 1 2019

Fingerprint

Balloon Occlusion
Aorta
Emergencies
Hemorrhage
Torso
Thoracotomy
Exsanguination
Mortality
Health Services Needs and Demand
Economic Inflation
Femoral Artery
Constriction
Blood Pressure
Wounds and Injuries

Keywords

  • aortic occlusion
  • balloon
  • catheter
  • complication
  • hemorrhage
  • junctional hemorrhage
  • REBOA
  • resuscitative endovascular balloon occlusion of the aorta

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Resuscitative Endovascular Balloon Occlusion of the Aorta : A Review for Emergency Clinicians. / Long, Brit; Hafen, Lee; Koyfman, Alexander; Gottlieb, Michael.

In: Journal of Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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