HWN Suggests

REBOA: The Next Stop on the Road to Trauma Management?

Today, we have several novel concepts being implemented across the world to try to move the needle for trauma resuscitation. Tranexamic acid (TXA), blood product administration, and simple (finger) thoracostomy are a few of the advances that seem to be gaining interest in EMS. Although these developments are still “state of the art” practice in EMS, many are wondering what the next stop is on the road to trauma management.

The next stop may be resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock with uncontrolled abdominal, pelvic, or lower extremity bleeding.

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Featured

  REBOA: Where are we now?

So there is a gap in care for the acute exsanguinating trauma patient with non-compressible haemorrhage and REBOA is a tempting solution. But does it work? The evidence is not plentiful and what is there is far from clear.

 Big T Trauma Series Ep. 2 – REBOA

This episode covers all things REBOA, including indications, practical tips and tricks, and complications. Don’t be shy – have a listen.

 From TXA to REBOA: Advances in trauma care

Technological advances and training are moving hemorrhage control techniques from the battlefield to prehospital and emergency medicine.

 REBOA For What Now???

By now REBOA (resuscitative endovascular balloon occlusion of the aorta) is becoming almost a household name in Emergency Medicine and Trauma – some love it, some hate it, most agree there is some role for it, many know that they will probably not see a need for it in their system. The research around it continues to develop and is becoming a little stronger – but much, if not all has been focused on use in trauma. Is there any role in medical cardiac arrest?

 REBOA in resuscitation

Tends to cause less physiological disturbance and have higher rates of technical success than aortic cross clamping...

 REBOA: Ready for Prime Time?

For years, the resuscitative thoracotomy has been the sole weapon in the physician’s arsenal against a loss of a perfusing pressure in the crashing trauma patient. With the advent of new endovascular technologies, novel methods to control hemorrhage are being refined, among them Resuscitative Endovascular Balloon Occlusion of the Aorta or REBOA. With this newer method getting a lot of attention in the emergency and trauma communities, it’s time to take a look at what it is, how successful it is, and where we are going with it.

Articles of Interest

Maimonides Emergency Medicine

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a procedure that involves placement of an endovascular balloon in the aorta to control hemorrhage and to augment afterload in traumatic arrest and hemorrhagic shock states. Evidence has show that REBOA tends to cause less physiological disturbance and has higher rates of technical success than aortic cross clamping that is commonly done with a thoracotomy.

Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA

REBOA is not without significant risk. Occlusion of the aorta results in tissue ischemia followed by reperfusion injury, predisposing to organ dysfunction and cardiovascular collapse. In addition, several technical complications have been reported which impact lower limb perfusion. As a result, appropriate patient selection is critical to balancing the potential risks and benefits of REBOA use.

Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta in Neurotrauma: Three Cases

In this report on REBOA performed in a clinical setting for polytrauma patients with spinal cord injury or TBI, the physiological effects of REBOA in neurotrauma are reviewed.

In the Zone: lessons from the first Canadian emergency department application of resuscitative endovascular balloon occlusion of the aorta (REBOA)

At our institution, while we have used REBOA within the operating room (OR), herein, we describe the first deployment of this technology in a Canadian emergency department...

REBOA may Be Helpful for Some Trauma Patients with Massive Bleeding

By temporarily stabilizing the hemodynamics of exsanguinating patients, it’s possible that REBOA could replace resuscitative thoracotomy (RT), Dr. David Thomas McGreevy of Oerebro University Hospital, in Sweden, and colleagues note in a paper in Shock.

REBOA, RE-RE-RE-REBOA

Resuscitative endovascular balloon occlusion of the aorta (REBOA) was first used 50 years ago in the Korean War but was not mentioned in emergency medicine literature until 1986. Its use declined in the 1990s and early 2000s, but during the past decade, it has gained the attention of trauma surgeons in military and civilian settings, potentially due to advances in the technology and smaller catheter sizes. The evidence for REBOA is conflicting.

To Do REBOA or Not to Do REBOA?

Traditionally used on the battlefield to prevent hemorrhage-related casualties, REBOA has gained traction in the civilian trauma setting over the past few years, with more than 300 hospitals adopting the technique worldwide Despite REBOA’s growing popularity, experts continue to debate when its use is appropriate.

Resources

Cobra-OS

When treating an unstable bleeding patient, you need to act fast. With the COBRA-OS™, you can buy precious time for a patient to be transferred to an operating room for definitive bleeding control. Utilizing the REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) technique, the low-profile and intuitive 4 French design of the COBRA-OS™ means there may be less chance of complications.