Patients who receive REBOA at a Role 2 and need to be evacuated to a higher level of care should have hemorrhage control addressed, and balloon deflated prior to transfer.
Under no circumstance should a Zone 1 complete occlusion REBOA remain inflated during transport. In rare situations when a short-distance rotary-wing evacuation to higher level of care is possible, a Zone 3 REBOA inserted at Role 2 may remain inflated during transport, however, this requires exceptional communication and planning to avoid undue risk of ischemic injury.
Partial aortic occlusion has prolonged treatment times to at least 2 hours in Zone 1 and at least 4 hours in Zone 3. It is now considered feasible to transport a patient with a provider trained in partial REBOA if it is expected to arrive at the location to provide definitive hemorrhage control within these time recommendations.
If transport is available, a medical provider trained in hemodynamic monitoring and manipulation of the occlusion balloon should always accompany the casualty. If a REBOA sheath is in place in a trauma patient, re-placement/re-inflation of the balloon during transport is an option for trained providers in the event of sudden profound hypotension. Simultaneous blood transfusion should be anticipated, and partial occlusion should be achieved as described above.
The essential equipment for REBOA is provided in Appendix J while the appropriate technical steps and considerations are summarized in Appendix C.