The balloon should be deflated once definitive hemorrhage control has been obtained. Communication with the assistant holding the apparatus securing the catheter and the anesthesia team is critical before consideration of deflating the balloon. When deflating the balloon, turn the three-way stopcock and withdraw saline slowly and deflate the balloon slowly. A good rule of thumb is to deflate the balloon 1 ml every minute. During and after balloon deflation, the team should be prepared for hemodynamic changes related to reperfusion, washout of metabolic byproducts, and acidosis. Ensure adequate blood product resuscitation prior to balloon deflation.
Complete Occlusion:
If using complete occlusion catheters (ER-REBOA-PLUS™, COBRA-OS®, etc.) this step can be anticipated to result in a significant decrease in afterload and hypotension and may result in cardiac collapse. Additional resuscitation may be needed even with slow balloon deflation. The user can anticipate approximately a 10% change in flow past the balloon during deflation with as little as 0.2 ml of fluid removal. Intermittent balloon inflation and deflation may be necessary during ongoing resuscitation until hemodynamic stability is restored.
Partial Occlusion:
If using pREBOA-PRO™ the user is advised to gradually remove fluid from the balloon every 10 minutes to increase the distal SBP by 20 mmHg. These small adjustments in flow over time should mitigate the ischemic reperfusion changes often encountered with removing an aortic clamp or deflating a complete occlusion aortic balloon. This slow deliberate deflation method will minimize the need for reinflation unless further hemorrhage is encountered.