Resuscitative endovascular balloon occlusion of aorta (REBOA): expanding the window of survival in massive bleeding

M R N Cassim,David T Mcgreevy,Mandika Wijeyaratne,Tal M Horer,Amila Sanjiva Ratnayake,Ajith Malalasekera

doi:10.4038/sljs.v39i2.8849

Abstract

Exsanguinating hemorrhage is responsible for 30 to 40% of early deaths from trauma and most of these deaths occur within the first few hours of injury 1. A study by A. Alarhyem et al. in 2016 revealed a precipitous rise in trauma deaths in victims with high grade injuries with pre-hospital time

Highlights

Exsanguinating haemorrhage is responsible for 30 to 40% of early deaths from trauma, and most of these deaths occur within the first few hours of injury [1]
First described for trauma patients during the Korean War, aortic balloon occlusion has been in clinical use for more than 25 years in the field of vascular surgery, mainly as part of the treatment algorithm in ruptured abdominal aortic aneurysms and endovascular aortic repair (EVAR) [3]
Due to developments in endovascular techniques and catheter technology, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged and gained popularity in the last few years as a method for bleeding control in trauma. It is a relatively simple, minimally invasive method to temporarily occlude the aorta aiming at reducing the bleeding, gaining hemodynamic stability and maintaining perfusion to the heart and brain, fundamentally gaining time to definitive surgical management [4].REBOA is one of the tools of EndoVascular resuscitation and Trauma

Summary

Introduction

Exsanguinating haemorrhage is responsible for 30 to 40% of early deaths from trauma, and most of these deaths occur within the first few hours of injury [1]. The EVTM concept aims to combine modern endovascular and hybrid techniques and procedures, such as REBOA with traditional Advanced Trauma Life Support (ATLS) and Definitive Surgical Trauma Care (DSTC) for early multidisciplinary evaluation, resuscitation, and definitive management of hemodynamically unstable patients. First described for trauma patients during the Korean War, aortic balloon occlusion has been in clinical use for more than 25 years in the field of vascular surgery, mainly as part of the treatment algorithm in ruptured abdominal aortic aneurysms (rAAA) and endovascular aortic repair (EVAR) [3].

Results

Conclusion