Advanced resuscitation teams may be utilized in austere environments as a bridge to surgical hemorrhage control. Data on the effectiveness of this approach are lacking. However, the development of the partial occlusion REBOA catheter opens a window for potential use prior to surgical team handoff.

Use of partial REBOA in the austere, prolonged casualty care environment brings along its own complex set of problems. However, these problems, if planned for correctly, can be addressed. The use of in-line mean arterial pressure monitoring devices to monitor aortic pressures are crucial, as this provides the ability to monitor balloon effectiveness as well as the effectiveness of the resuscitation process. Obtaining the necessary insertion supplies (see Appendix J) as well as planning and training for these scenarios will ensure proper preparation should this need arise. Unit-specific plans should be assessed to maximize readiness. Planning for the use of partial REBOA in the prolonged casualty care (PCC) population should ensure all members of the team are in agreement and should only be considered by fully trained and equipped resuscitation teams. The standards laid out in this CPG should be the building blocks of the unit specific PCC plan of care.

Partial REBOA in this setting may be considered if all the following conditions are met:

1. The casualty would otherwise die prior to reaching a surgical team without REBOA (NCTH, refractory hemorrhagic shock).
2. The team is trained in partial REBOA therapy.
3. Blood product resuscitation, preferably whole blood, is available but failing to resuscitate the patient.
4. Time to surgical team handoff is less than 2 hours for Zone 1, less than 4 hours for Zone 3.