Current Recommendations

- For the purpose of this CPG, the use of REBOA forward deployed requires training of all team personnel and expedient access to a damage control surgery capability.

REBOA use remains contraindicated in the setting of major thoracic hemorrhage or pericardial tamponade.

- Partial REBOA is conditionally preferred over complete REBOA. This requires training of all surgical and damage control resuscitation team personnel and acquisition of the partial occlusion device. The pREBOA-PRO™ catheter is currently the only FDA-approved catheter for partial aortic occlusion.
- For accurate titration of partial REBOA, central arterial blood pressure should be measured above and below the balloon, this requires a two arterial line transducer set up. A target central aortic SBP of 90-110 mmHg above the balloon, and minimum pulsatile SBP of 20 mmHg below the balloon, while titrating distal pressure to a target systolic blood pressure of 20 - 50 mmHg is desirable in partial occlusion.49 Of note: the pREBOA-PRO™ catheter provides the ability to measure above and below the catheter without additional access.
- Partial aortic occlusion of Zone 1 should ideally be limited to 2 hours, and Zone 3 should be limited to 4 hours. This continues to be an active area of clinical and animal research at the time of publication of this CPG.
- Complete aortic occlusion should be limited to less than 60 minutes in Zone 1, optimally < 30 minutes. When placed in Zone 3, keep RAO < 60 minutes.

Trained nurses or medics 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 REBOA must be determined at each site based on training, experience, local resources, expedient availability of a damage control surgery capability, 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 F of this CPG.