Resuscitative endovascular balloon occlusion of the aorta

Overview

Aortic segments.

Branches of the aorta.

• Abbreviation: REBOA
• Type of catheter based hemorrhage control
• Hemorrhage is a leading cause of trauma-related mortality
• REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy
• Research is ongoing, but has yet to demonstrate a mortality benefit
  • Retrospective case-control analysis found higher mortality for REBOA patients compared to similar cohort, higher complication rates of AKI and lower limb amputation

REBOA Zones

• Zone 1: From left subclavian artery to the celiac trunk
• Zone 2: From the celiac trunk to the lowest renal artery
  • Zone 2 is an unused zone because if of difficulty in occluding the bleeding vessel at this aortic location
• Zone 3: From lowest renal artery to the aortic bifurcation

Indications

• Non-compressible hemorrhage below the diaphragm in the abdomen, pelvis or retroperitoneum
• Positive FAST
• Pelvic fracture with negative FAST
• Traumatic cardiac arrest without aortic dissection or pericardial tamponade
• Suspected traumatic abdominal hemorrhage (Zone I REBOA)
• Blunt pelvic injury or groin junctional hemorrhage (Zone III REBOA)

Contraindications

• Age ≤18 or ≥70y
• Atraumatic cardiac arrest
• Proximal traumatic aortic dissection
• Proximal aortic dissection
• Cardiac tamponade

Equipment Needed

• Ultrasound
• REBOA Kit

Procedure

1. Immediately perform a FAST exam to assess for pericardial tamponade (contraindication)
2. Access the common femoral artery under ultarsound guidance and place a standard 18G arterial line
3. Pass a 260cm guidewire through that arterial line up to the level of the left subclavian
4. Obtain a chest Xray if feasible to confirm the position of the guidewire
5. Estimate length of catheter insertion based on desired location and external landmarks
   • Zone 1: Xiphoid process for Zone 1 (aprox 50cm)
   • Zone 3: umbilicus for Zone 3 (approx 40cm)
6. Place the REBOA 12 French arterial line introducer sheath
7. Advance the catheter over the wire through the sheath, then inflate the balloon with saline in the desired zone
   • Resistance will be felt as the balloon inflates against the wall of the aorta and blood pressure will increase substantially if successful

Complications

• Failure to access the common femoral artery

See Also

• Thoracotomy
• Pericardial tamponade
• Thoracic trauma
• Abdominal trauma
• Arterial line

External Links

• REBOA 101 ERCast

Videos

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