BackgroundUse of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemorrhage control in severe non-compressible torso trauma remains controversial, with limited data on patient selection and outcomes. This study aims to analyze the nationwide trends of its use in the emergency department (EDs). MethodsA retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) from 2017 to 2022 was performed, focusing on REBOA placements in EDs. ResultsThe analysis included 3398 REBOA procedures. Majority patients were male (76 %) with a median age of 40 years (27–58) and injury severity score of 20 (20–41). The most common mechanism was collision (64 %), with emergency surgeries most frequently performed for pelvic trauma (14 %). Level 1 trauma centers performed 82 % of these procedures, with consistent low annual utilization (<200 facilities). Survival rates were 85 % at 1-h post-placement, decreasing significantly to 42 % by discharge. ConclusionsREBOA usage in remains limited but steady, primarily occurring at level 1 trauma center EDs. While short-term survival rates are favorable, they drop significantly by the time of discharge.