Citation, DOI, disclosures and article data
Citation:
Sheikh Z, Sharma R, Botz B, et al. Resuscitative endovascular balloon occlusion of the aorta. Reference article, Radiopaedia.org (Accessed on 08 May 2024) https://doi.org/10.53347/rID-60750
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a treatment for hemorrhagic shock used in major trauma patients with life-threatening abdominal or lower limb bleeding.
The aortic balloon is delivered on a catheter via the femoral artery in order to reduce any distal bleeding and raise blood pressure in order to buy time for definitive surgical hemostasis. It has been used both in the pre-hospital and emergency room setting in a small number of trauma patients but high-quality data on its efficacy remains lacking 1.
Potentially used in selected adult patients aged 18-69 years with suspected of confirmed internal hemorrhage below the level of the diaphragm:
age >70 years
pre-existing terminal illness or significant co-morbidity
high suspicion of proximal traumatic aortic dissection
groin vessels not immediately identifiable on ultrasound
PEA arrest >10 minutes
cardiac arrest from other causes than exsanguination
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significant non-compressible hemorrhage above the diaphragm
There is a reported 4-5% incidence of arterial puncture related complications from the procedure 3.
Mortality in these patients remains high at between 34-64% with a lack of high-quality data for the effectiveness of REBOA 4.
Generally two zones are used for temporary aortic occlusion:
zone one: above the celiac axis, the ideal position for suspected active abdominal bleeding
zone three: below the lowest renal artery, typically used in case of pelvic trauma
zone two: lies between the above two zones, should not be used as it endangers mesenteric and renal circulation
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1. Emiliano Gamberini, Federico Coccolini, Beatrice Tamagnini, Costanza Martino, Vittorio Albarello, Marco Benni, Marcello Bisulli, Nicola Fabbri, Tal Martin Hörer, Luca Ansaloni, Carlo Coniglio, Marco Barozzi, Vanni Agnoletti. Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature. (2017) World Journal of Emergency Surgery. 12 (1): 42. doi:10.1186/s13017-017-0153-2 - Pubmed
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2. Brenner M, Bulger EM, Perina DG, Henry S, Kang CS, Rotondo MF, Chang MC, Weireter LJ, Coburn M, Winchell RJ, Stewart RM. Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). (2018) Trauma surgery & acute care open. 3 (1): e000154. doi:10.1136/tsaco-2017-000154 - Pubmed
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3. Manzano-Nunez R, Orlas CP, Herrera-Escobar JP, Galvagno S, DuBose J, Melendez JJ, Serna JJ, Salcedo A, Peña CA, Angamarca E, Horer T, Salazar CJ, Lopez-Castilla V, Ruiz-Yucuma J, Rodriguez F, Parra MW, Ordoñez CA. A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients. (2018) The journal of trauma and acute care surgery. doi:10.1097/TA.0000000000001978 - Pubmed
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5. Marcela De La Hoz Polo, Amandeep Sandhu, Elika Kashef, et al. Medical and surgical devices in the emergency and trauma patient: what the radiologist should know, and how they can add value. (2020) The British Journal of Radiology. doi:10.1259/bjr.20200530
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4. Emiliano Gamberini, Federico Coccolini, Beatrice Tamagnini, Costanza Martino, Vittorio Albarello, Marco Benni, Marcello Bisulli, Nicola Fabbri, Tal Martin Hörer, Luca Ansaloni, Carlo Coniglio, Marco Barozzi, Vanni Agnoletti. Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature. (2017) World Journal of Emergency Surgery. 12 (1): 42. doi:10.1186/s13017-017-0153-2 - Pubmed
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