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Resuscitative endovascular balloon occlusion of the aorta

promise, practice, and progress?

Perkins, Zane B.; Lendrum, Robbie A.; Brohi, Karim

Current Opinion in Critical Care: December 2016 - Volume 22 - Issue 6 - p 563–571
doi: 10.1097/MCC.0000000000000367
TRAUMA: Edited by Kjetil Sunde and Christina Gaarder
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Purpose of review Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and highlight priority areas for further research.

Recent findings REBOA is a feasible method of achieving temporary aortic occlusion and can be performed rapidly, with a high degree of success, in the emergency setting (including at the scene of injury) by appropriately trained clinicians. The procedure supports central perfusion, controls noncompressible haemorrhage, and may improve survival in certain profoundly shocked patient groups; but is also associated with significant risks, including ischaemic tissue damage and procedural complications. Evolutions of this strategy are being explored, with promising proof-of-concept studies in the fields of partial aortic occlusion and the combination of REBOA with extracorporeal support.

Summary Noncompressible torso haemorrhage is the leading cause of preventable trauma deaths. The majority of these deaths occur soon after injury, often before any opportunity for definitive haemorrhage control. For a meaningful reduction in trauma mortality, novel methods of rapid haemorrhage control are required.

aCentre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London

bNHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, UK

Correspondence to Karim Brohi, FRCS FRCA, The Royal London Hospital, Whitechapel, London, E1 1BB, UK. Tel: +44 77 0319 0545; fax: +020 7377 7044; e-mail: karim@trauma.org;k.brohi@qmul.ac.uk

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