ACEP and ACS recommends REBOA for traumatic life threatening hemorrhage below diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.
Few studies have also evaluated the utility of REBOA in non traumatic cardiac arrest to improve the probability of achieving ROSC as REBOA during CPR can increase cerebral and coronary perfusion. Utility REBOA has also been tried in obstetric emergencies like PPH, Placenta accerta.
The aorta is divided into three zones for REBOA purposes:
- Zone I: From the origin of the left subclavian artery to the coeliac artery
- Zone II: From the coeliac artery to the most caudal renal artery
- Zone III: From the most caudal renal artery to the aortic bifurcation
Zone 1 occlusion is indicated in abdominal hemorrhage . Zone 3 occlusion is indicated in pelvic hemorrhage.
Complication
- Access site complication
- Vessel dissection
- Pseudoaneurysm
- Perforation
- Rupture
- Air embolisation
- Peripheral limb ischemia
Evidence
- UK-REBOA Trial Jansen et al (JAMA. 2023) did a pragmatic RCT involving 90 patients REBOA group (46) and standard care (44) to determine the effectiveness of resuscitative endovascular ballon occlusion of the aorta in trauma patients with exsanguinating hemorrhage. Study found that REBOA didn't reduce 90 day mortality (25,54%) compared to standard group (18,42%).
- Brede et al (J Am Heart Assoc. 2019) did a feasibility study of pre hospital REBOA in non traumatic cardiac arrest.Study was done on 10 patients with 80% sucess rate of first attempt cannulation and 6 patient achieved ROSC. Study also found a improvement of ETCO2 after occlusion suggesting improved organ circulation during CPR.
Reference
- Barnard EB, Morrison JJ, Madureira RM, Lendrum R, Fragoso-Iñiguez M, Edwards A, Lecky F, Bouamra O, Lawrence T, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta (REBOA): a population based gap analysis of trauma patients in England and Wales. Emerg Med J. 2015 Dec;32(12):926-32. doi: 10.1136/emermed-2015-205217. PMID: 26598631; PMCID: PMC4717355.
- REBOA: Expanding Applications From Traumatic Hemorrhage to Obstetrics and Cardiopulmonary Resuscitation, From the AJR Special Series on Emergency Radiology.https://doi.org/10.2214/AJR.22.27932
