The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has become a topic of considerable interest as of late, primarily to treat non-compressible truncal hemorrhage (NCTH). However, it is beginning to expand into other causes of non-compressible bleeding.
Why do we care?
Is this REBOA thing new?!
How do I put in a REBOA?
|CODA Balloon Catheter|
|REBOA in Zone I|
|PRYOR MEDICAL Prytyme ER-REBOA Catheter|
Changes to the new design include, but are not limited to:
- More rigidity and thus guidewire-free
- Requires only a 7F introducer sheath eliminating the need for arterial repair on removal
- A protective “p-tip” to avoid vascular injury on insertion
- External landmarks for more accurate placement without additional equipment and a proximal arterial line port in order to accurately measure blood pressure following balloon inflation.
One would expect these design improvements to not only improve provider placement and use of the balloon, but potentially improve patient outcomes, however this has yet to be proven in the literature.
Does REBOA work?
Additionally, as presented by Dr. Gareth Grier at the scientific meeting of AGN in Graz, Austria in April 2016, the prehospital HEMS service in London has placed 5 prehospital REBOA catheters and an additional 4 on arrival to hospital, and have had no deaths due to bleeding, further demonstrating the efficacy of REBOA.
Who gets REBOA?
As with many invasive procedures in critically ill patients (eg. ECMO), the million dollar question really is who gets REBOA. Trauma centres in both Denver (from manuscript; below) and Baltimore (below; widely available on internet) have proposed various algorithms in order to determine who gets REBOA in the trauma bay, and where REBOA should be placed (ie. Zone I vs Zone III)
It’s not all roses…
- increased IL-6 levels
- increased norepinephrine requirements for hemodynamic instability
- increased incidence of ARDS.
The future of REBOA