The utilization of resuscitative endovascular balloon occlusion of the aorta: preparation, technique, and the implementation of a novel approach to stabilizing hemorrhage

With advances in technology and medical science, treatment methods of trauma patients are constantly improving; however, noncompressible torso hemorrhage (NCTH), such as a massive hemorrhage associated with pelvic ring, abdominal, and thoracic injuries, remains the main cause of preventable death (1-4). Therefore, rapid and effective procedures are needed to achieve hemostasis in cases of traumatic torso hemorrhage. Resuscitative thoracotomy (RT) followed by aortic cross clamping (ACC, hereafter referred to as RT-ACC) might be performed as damage control surgery (DCS) to decrease the hemorrhage below the clamping site and to increase cerebral and coronary perfusion in these patients (5,6). Unfortunately, RT still demonstrates high morbidity and mortality rates (5,7); it is especially limited in patients with hemorrhagic shock and cardiac arrest from trauma (7). Presently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been gaining acceptance as an alternative to ACC to achieve hemostasis in NCTH patients presenting in extremis (3-6,8-11). It offers a less invasive approach for salvaging severely injured patients with hemorrhage compared with RT (4,5,12). REBOA could be more effective and easier to perform than ACC as an aspect of occlusion level for bleeding control and total/partial/intermittent occlusion to avoid organ ischemia (5,13,14). Furthermore, field REBOA/prehospital REBOA may be an option to manage torso hemorrhage (15,16). Despite its effectiveness in end-stage hemorrhagic shock, the application of REBOA in trauma patients remains limited. The aim of study was to provide a conceptual understanding, environmental settings and technical methods in implementing REBOA