Resuscitative endovascular balloon occlusion of the aorta

Overview

• 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

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 truncal hemorrhage
• Traumatic cardiac arrest

Contraindications

• Proximal aortic dissection
• Cardiac tamponade

Procedure

1. Access the common femoral artery and place a standard 18G arterial line
2. Pass a 260cm guidewire through that arterial line up to the level of the left subclavian
3. Obtain a chest Xray if feasible to confirm the position of the guidewire
4. Estimate length of catheter insertion based on desired location and external landmarks
   • Zone 1: xiphoid process for Zone 1
   • Zone 3: umbilicus for Zone 3
5. Place the REBOA 12 French arterial line introducer sheath
6. 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

External Links

• REBOA 101 ERCast