„Resuscitative endovascular balloon occlusion of the aorta“

K. Elias, M. Engelhardt

Severe hemorrhage remains the leading cause of death among trauma patients. Resuscitative balloon occlusion of the aorta (REBOA) is an endovascular alternative to the established emergency room thoracotomy with cross-clamping of the aorta in patients with severe abdominal or pelvic bleeding. The article reports on initial experiences with REBOA. Based on the literature and own experiences the pathophysiology, indications, contraindications, technical details and first results with REBOA are presented. The REBOA procedure is indicated in patients with treatment-refractive hemorrhagic shock with severe abdominal or pelvic bleeding. Via a transfemoral approach a balloon catheter is placed in the aorta and inflated. Depending on the indication the aortic occlusion is located in a supradiaphragmatic (zone 1) or infrarenal (zone 3) position. Experimental results proved a significant increase in central perfusion pressure after performance of REBOA. Furthermore, first clinical data indicate an improved patient survival rate after trauma. Improvements of the devices and minimizing the access trauma using small 7 Fr sheaths decreased the perioperative complication rate. The REBOA procedure is a promising endovascular technique for temporary stabilization of the circulation in patients with hemorrhagic shock. Further clinical studies and registries have yet to prove its superiority over emergency room thoracotomy.