1. Resuscitate per advanced trauma life support
2. Rule out major thoracic trauma (CXR/EFAST/Bilateral chest tubes)
3. Confirm abdominopelvic source of shock (Physical Exam, FAST exam and Pelvic X-ray if blunt trauma)
4. Confirm bilateral femoral pulses are present
5. Establish arterial access with 4 Fr (COBRA-OS®) or 7 Fr Sheath (ER-REBOA-PLUS™ or pREBOA-PRO™) in an uninjured common femoral artery
6. Insert to Zone 1 or Zone 3 using the markings on the catheter
7. Evacuate the balloon
8. Flush the arterial line
9. Insert the catheter
10. Inflate the balloon
    • ER-REBOA-PLUS™: Zone 1 - start with 8 ml; Zone 3 - start with 2 ml
    • COBRA-OS®: Zone 1 – start with 8 ml (max 13 ml); Zone 3 – start with 2 - 3 ml
    • pREBOA PRO: Inflate to above the balloon SBP 90 - 110 (MAP 55 - 65) and evaluate below the balloon pressure for adequacy of partial occlusion
11. Secure the catheter
12. Control major bleeding
13. Monitor the patient, hemodynamics, catheter, and sheath
14. Resuscitate and deflate the balloon
15. Complete damage control surgery
16. Remove sheath when coagulopathy corrected
17. Check distal pulses after sheath removal