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Chapter 24 - Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

from Section 6 - Abdomen

Published online by Cambridge University Press:  21 October 2019

Demetrios Demetriades
Affiliation:
University of Southern California
Kenji Inaba
Affiliation:
University of Southern California
George Velmahos
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a compliant, endovascular balloon designed to occlude the thoracic or lower abdominal aorta in hemorrhagic shock, for temporary control of bleeding in the abdomen or pelvis.

  • The REBOA catheter is placed through a sheath in the right or left common femoral artery, accessed using anatomic landmarks, ultrasound guidance, or with open surgical technique. The balloon is then inflated in the thoracic or abdominal aorta, effectively acting as a minimally invasive aortic cross-clamp.

  • The procedure for placing a REBOA takes only a few minutes.

  • REBOA is ideally suited for hypotensive patients with abdominal or pelvic bleeding and can be placed in the emergency room, intensive care unit, or the operating theater.

  • REBOA balloon placement can be guided and confirmed using external landmarks, X-ray, fluoroscopy, or ultrasound. Balloon inflation volumes are titrated based on invasive blood pressure monitoring, haptic feedback, and imaging.

  • REBOA is contraindicated in patients with intrathoracic, neck, or facial bleeding, in cases with high suspicion for blunt thoracic aortic injury, and in patients in cardiac arrest.

  • Aortic occlusion is a temporary, resuscitative measure and should be considered a transition to definitive care. After inflation, the patient should be immediately transported to the operating room or the interventional suite for definitive management of their traumatic injuries.

  • REBOA balloon inflation results in distal ischemia and as such, occlusion times should be minimized.

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Publisher: Cambridge University Press
Print publication year: 2020

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