REBOA Steps

REBOA can be considered in 6 sequential steps:

1. Arterial access and positioning of sheath
2. Positioning of the balloon
3. Inflation of the balloon
4. Establish degree of aortic occlusion (partial vs complete)
5. Operative/procedural control of bleeding
6. Deflation of the balloon
7. Sheath removal

REBOA can be performed preemptively in patients with high-risk injury patterns and unstable physiologic parameters as described above. In this way, REBOA can be proactive rather than reactive in appropriate patients. The indications for REBOA are summarized in Appendix A for traumatic arrest and Appendix B in cases of profound shock. If proximal aortic occlusion is required, this is termed Zone 1, whereas distal aortic occlusion is termed Zone 3. Zone 1 REBOA deployment will be used in most patients presenting with hemorrhagic shock, and may be used in all patients with traumatic arrest, regardless of injury pattern, due to the benefits on a patient’s MAP.51,81