- For the purpose of this CPG, REBOA remains contraindicated in the setting of major thoracic hemorrhage or pericardial tamponade.
- ERT may improve cardiac index as well as coronary and cerebral perfusion pressure compared to closed chest compression.26 However, when closed chest compressions are combined with REBOA, cardiopulmonary resuscitation is more effective allowing for higher EtCO2 and cardiac compression fraction compared to open cardiac massage and aortic cross clamping.
- RAO poses a significant risk of life-threatening and limb-threatening complications. RAO is a time-critical intervention that should never be undertaken without expedient access to definitive hemorrhage control.1–19,7-28,14,17,20
- The major rate limiting step with REBOA is accurate and expedient common femoral artery (CFA) access. Ultrasound guided access is the preferred method for CFA access however, up to 50% of cases require open exposure. Smaller access sheaths are associated with improved outcomes.29-32
- Initial animal experiments demonstrated the potential merits of REBOA with occlusion times of up to 90 minutes.33-34 However, long occlusion times resulted in nonsurvivable metabolic derangements and organ damage. These side effects were significantly lessened with occlusion times less than 30 minutes.35
- Outcomes for Zone 1 REBOA are optimized if occlusion times are between 15-30 minutes (See Appendix C for an illustration of the Zones of the Aorta). Occlusion times over 30 minutes are associated with higher ischemic complications and higher mortality.17
- Outcomes for Zone 3 REBOA are optimized if occlusion times are 30-60 minutes, though survival following longer occlusion times has been reported.36
- The American Association for the Surgery of Trauma (AAST) prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) database contains cases with occlusion times exceeding the above recommendations, but this registry does not track the use of occlusion techniques such as intermittent and/or partial REBOA.41 Partial and intermittent balloon techniques may reduce distal ischemia and extend tolerable occlusion times.37-40 There is currently insufficient data to guide any consensus on this practice.42,36
- With increasing REBOA availability and provider experience, REBOA has successfully been utilized in multiple austere military locations.43-47 In austere resuscitations, REBOA has been shown to improve the ability to triage multiple casualties, allow for blood product conservation, and assist in creating a ‘bloodless’ environment for damage control surgery.45,47-48
- Properly trained nurses are responsible for assisting in equipment availability and setup, accurate documentation and recording of catheter insertion distance in addition to safe and accurate patient handoff during transfer/transport.
- The implementation of this technique must be determined at each site based on training, experience, local resources, and evacuation timelines.
- Documentation of Aortic Occlusion via open thoracotomy or REBOA will be done using the Aortic Occlusion (AO) Procedure Note that is found in Appendix H of this CPG