Resuscitative endovascular balloon occlusion of the aorta

Reboa.jpg

Overview

  • Abbreviation: REBOA
  • Hemorrhage is a leading cause of trauma-related mortality[1]
  • REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy
  • Research is ongoing, but has yet to demonstrate a mortality benefit[2]

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.[3]
  • Traumatic cardiac arrest without aortic dissection or pericardial tamponade

Contraindications

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 guid 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
    • Zone 3: umbilicus for Zone 3
  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

  • Not accessing the common femoral artery or accessing it blindly

See Also

External Links

References

  1. ↑ Tieu BH et al. Coagulopathy: Its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055–64
  2. ↑ Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Feb;80(2):324-34.
  3. ↑ Qasim, Zaffer, et al. “Resuscitative endovascular balloon occlusion of the aorta.” Resuscitation 96 (2015): 275-279.
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