REBOA Use, Practices, Characteristics, and Implementations Across Various US Trauma Centers

Abstract

Background Hemorrhage accounts for >30% of trauma-related mortalities. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for temporary hemostasis in the civilian population remains controversial. We aim to investigate REBOA practices through analysis of surgeon and trauma center characteristics, implementation, patient characteristics, and overall opinions. Methods An anonymous 30-question standardized online survey on REBOA use was administered to active trauma surgeon members of the Eastern Association for the Surgery of Trauma. Results A total of 345 responses were received, and 130/345 (37.7%) reported REBOA being favorable, 42 (12.2%) reported REBOA unfavorably, and 173 (50.1%) were undecided. The majority of respondents (87.6%) reported REBOA performance in the trauma bay. 170 (49.3%) of respondents reported having deployed REBOA at least once over the past 2 years. 80.0% reported blunt trauma being the most common mechanism of injury in REBOA patients. Resuscitative endovascular balloon occlusion of the aorta deployment in zone 3 of the aorta was significantly higher in patients reported to suffer a pelvic fracture or pelvic hemorrhage, whereas REBOA deployment in zone 1 was significantly higher among patients reported to suffer hepatic, splenic, or other intra-abdominal hemorrhage ( P < .05). Conclusion Among survey respondents, frequency of REBOA use was low along with knowledge of clear indications for use. While current REBOA usage among respondents appeared to model current guidelines, additional research regarding REBOA indications, ideal patient populations, and outcomes is needed in order to improve REBOA perception in trauma surgeons and increase frequency of use.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): Looking Back, Moving Forward

“…10 As a result, randomized controlled trials on swine models have guided understanding of the physiology and benefits of REBOA placement. 11 In controlled swine hemorrhage models, the average proximal mean arterial pressure (MAP) was significantly greater in Zone 1 compared with Zone 3 occlusion (127.9 § 1.3 vs. 53.4 § 1.1 mmHg). 12 In uncontrolled hemorrhage models, there is a brief supraphysiological MAP achieved directly after inflation, which is transient as hemorrhage continues and causes a decrease in blood pressure for the remaining 30 to 60 minutes of inflation.…”

Management of major bleeding for anticoagulated patients in the Emergency Department: an European experts consensus statement

“…An SBP of 80-90 mmHg should be the target if no brain injury is suspected ('permissive hypotension') with restricted volume therapy using isotonic crystalloids until the target blood pressure (BP) is achieved [18]. In some emergency medical systems, prehospital blood transfusion and the application of an endovascular balloon occlusion are available [19].…”

A survey of resuscitative endovascular balloon occlusion of the aorta (REBOA) program implementation in Canadian trauma centres

“…There are no prior studies on the practice of REBOA at Canadian trauma centres. A recent study of 345 trauma surgeons in the United States found that 49.3% (170/345) had performed REBOA at least once within the past 2 years; 37.7% of respondents had an overall favorable opinion of REBOA, while 12.2% had an unfavorable opinion and 50.2% were undecided [8].…”