Open Access Surgery (Oct 2024)
Is Occlusion the Solution? REBOA as a Hemorrhage Control Adjunct
Abstract
Sarah K Lee,1 Kaushik Mukherjee2 1Department of Plastic Surgery, University of California Irvine Health, Irvine, CA, USA; 2Division of Acute Care Surgery, Loma Linda University Health, Loma Linda, CA, USACorrespondence: Kaushik Mukherjee, Division of Acute Care Surgery, Loma Linda University Health, 11175 Campus Street, CP, 21111, Loma Linda, CA, 92350, USA, Tel +001 909-558-4286, Fax +001 909-558-236, Email [email protected]: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a promising intervention for hemorrhagic shock and traumatic injury management, offering a minimally invasive means of aortic occlusion compared to resuscitative thoracotomy. While REBOA’s origin dates back to the 1950s, recent advancements have made it more accessible and applicable in various clinical scenarios. REBOA has become increasingly utilized in not only the exsanguinating trauma patient but also in non-traumatic hemorrhage as a bridge to definitive hemostatic control. This article reviews the procedure and mechanism, clinical applications, and challenges associated with the REBOA. There are several challenges to consider when implementing the REBOA, particularly in procedural execution and patient selection. Determining the ideal candidates for REBOA remains inconclusive, with varying outcomes reported in different patient populations. Additionally, the potential for ischemic complications, such as visceral organ injury, end organ damage, and lower extremity ischemia, underscores the critical importance of procedural planning and ongoing monitoring. Partial and intermittent REBOA techniques have been introduced to mitigate ischemic complications associated with complete occlusion, but their efficacy and safety warrant further investigation. Beyond technical considerations, logistical and institutional factors pose as potential barriers to the effective utilization of REBOA, highlighting the importance of standardized training and a multidisciplinary approach when establishing a REBOA program. REBOA offers promising advancements in hemorrhage control, and the technology continues to evolve to address potential challenges and complications. Further research is imperative to delineate its optimal use and potential impact on patient outcomes.Keywords: traumatic hemorrhagic shock, REBOA, postpartum hemorrhage, partial REBOA, aortic occlusion, endovascular
