Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a potential pre-hospital procedure for the control of non-compressible haemorrhage: A Literature Review

Alana Valkenburg, Daniel Bennett, Jack Bishop, Gavin Smith

Abstract


Introduction

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.

Method

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.

Results

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.

Conclusion

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.


Keywords


Haemorrhage, REBOA, trauma

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References


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DOI: http://dx.doi.org/10.33151/ajp.12.4.146

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