Resuscitative endovascular Balloon Occlusion of the Aorta (REBOA) has evolved as a potentially life-saving therapy for the control of non-compressible haemorrhage. With the development of a fluoroscopy free method, the feasibility of introducing REBOA to the pre-hospital setting may lessen the impact of trauma related morbidity and mortality and enhance the level of care provided by emergency services.
A comprehensive search of the electronic databases was conducted using
MEDLINE with Full Text (via EBSCOHost), PubMed and Science Direct. The search included the following keywords: “Resuscitative Endovascular Balloon Occlusion of the Aorta”, “REBOA”, “thoracotomy”, “aortic clamping”, “Trauma”, “hypovolaemia” and “pre-hospital”. Cross-referencing using the reference lists of the found articles was used to identify further relevant articles. Studies involving paediatric patients or rats were excluded. Only those articles published after the year 2000 were included.
From the examined literature, it can be determined that there is a definitive absence of pre-hospital attention given towards REBOA, despite its proven benefits in central aortic pressures, mean systolic pressures and overall brain oxygenation. When compared against thoracotomy, as an alternative technique of aortic occlusion, REBOA provided an enhanced metabolic profile and required less resuscitation thereby inducing a greater survivability rate.
The REBOA procedure has reported benefit over aortic cross clamping as a method of proactive aortic control of exsanguinating haemorrhage in porcine and human studies, yet its effectiveness as a pre-hospital technique for reducing mortality and morbidity in trauma patients is yet to be demonstrated within clinical studies.
Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for haemorrhagic shock. J Trauma 2011;71(6):1869–72.
Scott DJ, Eliason JL, Villamaria C, et al. A novel flouroscopy-free resuscitative endovascular aortic balloon occlusion system in a model of haemorrhagic shock. J Trauma Acute Care Surg 2013;75(1):122–8.
Davenport R. Haemorrhage control of the pre-hospital trauma patient. Scand J Trauma Resusc Emerg Med 2014;22(Suppl 1):1–2.
Andersen NG, Rehn M, Oropeza-Moe M, Oveland NP. Pre-hospital resuscitative endovascular balloon occlusion of the aorta. ibid. 2014;22(Suppl 1):19.
Markov NP, Percival TJ, Morrison JJ, et al. Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of haemorrhagic shock. Surgery 2012;153(6):848–56.
Morrison JJ, Lendrum RA, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta (REBOA): A bridge to definitive haemorrhage control for trauma patients in Scotland? The Surgeon. 2014;12(3):119–20.
Morrison JJ, Percival TJ, Markov NP, et al. Aortic balloon occlusion is effective in controlling pelvic haemorrhage. J Surg Res 2012;177(2):341–7.
White JM, Cannon JW, Stannard A, et al. Direct cascular control results in less physiologic derangement than proximal aortic clamping in a porcine model of non-compressable extrathoracic torso haemorrhage. J Trauma. 2011;71(5):1278-87.
White JM, Cannon JW, Stannard A, Markov NP, Spencer JR, Rasmussen TE. Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of haemorrhagic shock. Surgery 2011;150(3):400–9.
Horer TM, Skoog P, Nilsson KF, Oikonomakis I, Larzon T, Norgren L, et al. Intraperitoneal metabolic consequences of supraceliac aortic balloon occlusion in an experimental animal study using microdialysis. Annals of Vascular Surgery. 2014;28(5):1286-95.
Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, Scalea T. Basic endovascular skills for trauma course: Bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg 2014;22(2):286–91.
Brenner ML, Moore LJ, Dubose J, et al. A clinical series of resuscitative endovascular balloon occlusion of the aorta for haemorrhage control and resuscitation. ibid. 2013;75(3):506–11.
Martinelli T, Thony F, Declety P, et al. Intra-aortic balloon occlusion to salvage patients with life-threatening haemorrhagic shock from pelvic fractures. J Trauma 2010;68(4):942–8.
Gutierrez G, Reines HD, Wulf-Gutierrez ME. Clinical review: haemorrhagic shock. Crit Care 2004;8(5):373–81.
Lippi G, Favaloro EJ, Cervellin G. Massive post-traumatic bleeding: Epidemiology, causes, clinical features and therapeutic management. Semin Thromb Hemost 2013;39(1):83–93.
Morrison JJ, Ross JD, Markov NP, Scott DJ, Spencer JR, Rasmussen TE. The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock. J Surg Res 2014;187(2):1–9.
Morrison JJ, Mellor A, Midwinter M, Mahoney PF, Clasper JC. Is pre-hospital thoracotomy necessary in the military environment? Injury 2011;42(5):469–73.
Chilkias A. Prehospital emergency thoracotomy: when to do it? Australasian Journal of Paramedicine 2009;7(4):1–12.
Seamon MJ, Chovanes J, Fox N, et al. The use of emergency department thoracotomy for traumatic cardiopulmonary arrest. Injury 2012;43(9):1355–61.
Villamaria CCY, Eliason JL, Napolitano LM, Stansfield B, Spencccer JR, Rasmussen TE. Endovascular Skill for Trauma and Resuscitative Surgery (ESTARS) course: Curriculum development, content validation, and program assessment. J Trauma Acute Care Surg 2013;76(4):929–36.