Current use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma☆

Damage control resuscitation: REBOA as the new fourth pillar

“…This endovascular balloon technique is not a recent development, the first reports on this technique dates back to 1954 during the Korean War 40 , 41 . However, the development of a specific balloon catheter for hemorrhage control in trauma scenarios has only occurred recently, being the CTE Cali Group an international pioneer in its clinical implementation and a source of scientific evidence that has contributed to its consolidation in the field of trauma surgery 42 , 43 . Such findings have included the following:…”

“… REBOA is not only a tool that aids in the control of hemorrhage, it is also a vital tool in the hemodynamic resuscitation of a severely injured patient allowing for the intra-vascular volumetric content to remain directed towards essential organs which include the brain and the heart 44 , 45 REBOA is a dynamic tool that requires the placement and ongoing management by a skilled and well-trained surgeon 46 - 48 REBOA poses a new paradigm shift in which soon after the initial ABCDE evaluation proposed by ATLS, an introducer sheath should be placed via the common femoral artery in the Trauma Bay / ER, which allows for immediate ongoing real time blood pressure monitoring of the hemodynamically unstable severely injured trauma patient and if indicated (SBP <70 mmHg) the placement of a REBOA with the aim of reducing cell injury and hemodynamic decompensation by early proximal control of the source of bleeding in both blunt and penetrating trauma 42 , 46 , 49 , 50 …”

“…REBOA poses a new paradigm shift in which soon after the initial ABCDE evaluation proposed by ATLS, an introducer sheath should be placed via the common femoral artery in the Trauma Bay / ER, which allows for immediate ongoing real time blood pressure monitoring of the hemodynamically unstable severely injured trauma patient and if indicated (SBP <70 mmHg) the placement of a REBOA with the aim of reducing cell injury and hemodynamic decompensation by early proximal control of the source of bleeding in both blunt and penetrating trauma 42 , 46 , 49 , 50 …”

“…We propose a new paradigm “The Fourth Pillar”: Permissive Hypotension, Hemostatic Resuscitation, Damage Control Surgery and REBOA ( Figure 6 ). To this point, we have extended the indications of REBOA use and have applied it to salvage patients with penetrating and blunt trauma not only of the abdomen and pelvis 40 , 44 but also of the chest which until our reported initial successful experience was considered a contraindication 42 , 46 , 51 - 53 . However, we are not promoting its vast use for all trauma patients but instead its use in specific well indicated dire scenarios of hemodynamic instability from ongoing non-compressible torso hemorrhage and impending cardiac arrest 54 .…”

“…Esta técnica de control endovascular no es reciente, los primeros reportes datan del año de 1954 durante la guerra de Corea 40 , 41 . Pero, el desarrollo de un catéter con balón específico para el control de la hemorragia en escenarios de trauma solo ha ocurrido recientemente, siendo el grupo de cirugía de trauma y emergencias de Cali pionero a nivel internacional en su implementación clínica y fuente de evidencia científica que ha contribuido a su consolidación en el campo de la cirugía de trauma 42 , 43 . A partir de esta experiencia se presentan varias observaciones sobre el uso del REBOA:…”