Elsevier

Injury

Volume 47, Issue 12, December 2016, Pages 2603-2605
Injury

Editorial
Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

https://doi.org/10.1016/j.injury.2016.10.024Get rights and content

Introduction

Pelvic ring, thoracic and abdominal injuries are often seen in young adults with polytrauma presenting in a state of shock being at an increased risk of morbidity and mortality [1], [2], [3], [4], [5], [6].

Hemorrhage is the main cause of preventable death in both military and civilian trauma patients, thus affecting a young and otherwise healthy population [7], [8], [9], [10], [11], [12]. This fact remains unchanging despite heterogeneity of the samples reported in terms of trauma event, injury pattern and care resources available. Most of these patients perish by Non-Compressible Torso Hemorrhage (NCTH) [13]. The definition and management of this picture are constantly evolving. Many techniques have been developed in an effort to deal with the high mortality encountered; Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) being one of the most promising practices. Arisen from the field of great vessels surgery, this procedure has developed into an efficient tool in hemorrhage control and resuscitation. It offers a less invasive approach for the salvage of the most severely injured in comparison to resuscitative thoracotomy (RT), which may explain the increased uptake of this technique in many emergency departments [14], [15].

Section snippets

Physiological effects of the aortic occlusion: proximal and distal concerns

Numerous clinical and preclinical studies support the utility of REBOA in restoring hemodynamics in the context of hemorrhagic shock [15], [16], [17], [18], [19], [20], [21], [22]. Nonetheless, physiological tolerance to aortic occlusion is related to the metabolic and vascular impact in the areas proximal and distal to the balloon. Those effects have been described in animal models.

Ischemia of the tissues distal to the occlusion triggers the elevation in cytokines concentration. After balloon

Outcomes, features and keys for success

Survival rates of trauma patients undergoing REBOA from available studies (USA, Japan and Europe) range from 13% to 67% [14], [15], [16], [18], [20], [27], [29], [30], [31], [32], [33], [34]. Unfortunately, there are huge discrepancies in methodology, inclusion criteria and interventions. Recently, a multicenter REBOA registry has been created [15] and in time may produce interesting data which may clarify the role of this technique in modern resuscitation and, even, its advantage over RT.

The

The future: who and where?

As the use of REBOA gains popularity, there is an increasing need for high fidelity training models and teaching programs. One of the main advantages of this technique is that it can be acquired in a reasonable time frame and without significant endovascular surgical [40], [41]. There is however a need for further innovation particularly in respect of [1] deployment without imaging [2], small flexible delivery systems [3], wifi haemodynamic data and [4] stable aortic position [19], [26].

Most of

Summary

REBOA is a promising procedure that can save lives. It has temporary effects on hemostasis and hemodynamics, possessing the capacity to bridge the gap between shock and definitive care. The key for success is to achieve definitive hemostasis as soon as possible, for which focused resources are needed. Its great versatility and easy application makes REBOA accessible to many professionals and in different clinical scenarios. It is, however, a technique in its infancy and further clinical

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