Resuscitative Endovascular Balloon Occlusion of the Aorta: Review of the Literature and Applications to Veterinary Emergency and Critical Care

Abstract

While hemorrhagic shock might be the result of various conditions, hemorrhage control and resuscitation are the corner stone of patient management. Hemorrhage control can prove challenging in both the acute care and surgical settings, especially in the abdomen, where no direct pressure can be applied onto the source of bleeding. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising replacement to resuscitative thoracotomy (RT) for the management of non-compressible torso hemorrhage in human trauma patients. By inflating a balloon at specific levels (or zones) of the aorta to interrupt blood flow, hemorrhage below the level of the balloon can be controlled. While REBOA allows for hemorrhage control and augmentation of blood pressure cranial to the balloon, it also exposes caudal tissue beds to ischemia and the whole body to reperfusion injury. We aim to introduce the advantages of REBOA while reviewing known limitations. This review outlines a step-by-step approach to REBOA implementation, and discusses common challenges observed both in human patients and during translational large animal studies. Currently accepted and debated indications for REBOA in humans are discussed. Finally, we review possible applications for veterinary patients and how REBOA has the potential to be translated into clinical veterinary practice.

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

“…The total occlusion of the REBOA balloon has a protective effect on complications than intermittent or partial occlusion. Usually, total occlusion is known to have a higher ischemic burden than partial occlusion [18]. The current guideline for REBOA recommends that total occlusion time in Zone 1 does not exceed 30-45 minutes [19].…”

Lessons Learned From the Battlefield and Applicability to Veterinary Medicine—Part 1: Hemorrhage Control

“…In veterinary medicine, no standardized clinical guidelines or evidence-based best practice protocols currently exist for using REBOA to manage non-compressible torso hemorrhage ( 74 ). In canines, available data regarding endovascular balloon occlusion remains limited mainly to experimental models, particularly, as it applies to CPR ( 74 ).…”

“…In veterinary medicine, no standardized clinical guidelines or evidence-based best practice protocols currently exist for using REBOA to manage non-compressible torso hemorrhage ( 74 ). In canines, available data regarding endovascular balloon occlusion remains limited mainly to experimental models, particularly, as it applies to CPR ( 74 ). It remains hopeful that the experiences and data gained from these experimental CPR models may, in some part, translate to clinical practice for managing non-compressible hemorrhage ( 51 ).…”

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): update and insights into current practices and future directions for research and implementation

“…This is arguably the least complicated of the three zones, and is intended for control of bleeding in the pelvis and extremities [ 12 ]. Consensus opinions indicate that shorter periods of occlusion which minimize ischemic injury are best for patient survival, with Zone III generally allowing for longer periods of occlusion than Zone I (60–90 min for Zone III vs. 30–60 for Zone I) [ 13 ].…”