View source for Resuscitative endovascular balloon occlusion of the aorta

==Overview==
[[File:Aorta segments.jpg|thumb|Aortic segments.]]
[[File:Aorta branches.jpg|thumb|Branches of the aorta.]]
*Abbreviation: REBOA
*Type of catheter based hemorrhage control
*Hemorrhage is a leading cause of trauma-related mortality<ref>Tieu BH et al. Coagulopathy: Its pathophysiology and treatment in the injured patient. World J Surg. 2007;31:1055–64</ref>
*REBOA has been proposed as a less invasive alternative to resuscitative thoracotomy
*Research is ongoing, but has yet to demonstrate a mortality benefit<ref name="Morrison">Morrison JJ, Galgon RE, Jansen JO, et al. A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock. J Trauma Acute Care Surg. 2016 Feb;80(2):324-34.</ref>
**Retrospective case-control analysis found higher mortality for REBOA patients compared to similar cohort, higher complication rates of AKI and lower limb amputation <ref> Bellal Joseph, et al. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surg. 2019;154(6):500-508 </ref>

[[File:Reboa.jpg|thumb|]]

===REBOA Zones===
*'''Zone 1:''' From left subclavian artery to the celiac trunk
*'''Zone 2:''' From the celiac trunk to the lowest renal artery
**Zone 2 is an unused zone because if of difficulty in occluding the bleeding vessel at this aortic location
*'''Zone 3:''' From lowest renal artery to the aortic bifurcation

==Indications==
*Non-compressible [[hemorrhage]] below the diaphragm in the abdomen, pelvis or retroperitoneum <ref>Qasim, Zaffer, et al. “Resuscitative endovascular balloon occlusion of the aorta.” Resuscitation 96 (2015): 275-279.</ref> 
*Positive [[FAST]]
*[[Pelvic fracture]] with negative FAST
*[[Traumatic cardiac arrest]] ''without'' aortic dissection or pericardial tamponade
*Suspected traumatic abdominal hemorrhage (Zone I REBOA)
*Blunt pelvic injury or groin junctional hemorrhage (Zone III REBOA)

==Contraindications==
*Age ≤18 or ≥70y
*Atraumatic [[cardiac arrest]]
*Proximal [[traumatic aortic rupture|traumatic aortic dissection]]
*Proximal [[aortic dissection]]
*[[Cardiac tamponade]]

==Equipment Needed==
*Ultrasound
*REBOA Kit

==Procedure==
#Immediately perform a [[FAST]] exam to assess for [[pericardial tamponade]] (contraindication)
#Access the '''common femoral artery''' under ultarsound guidance and place a standard 18G arterial line
#Pass a 260cm guidewire through that arterial line up to the level of the left subclavian
#Obtain a chest Xray if feasible to confirm the position of the guidewire
#Estimate length of catheter insertion based on desired location and external landmarks
#*''Zone 1: Xiphoid process for Zone 1 (aprox 50cm)''
#*''Zone 3: umbilicus for Zone 3 (approx 40cm)''
#Place the REBOA 12 French arterial line  introducer sheath 
#Advance the catheter over the wire through the sheath, then inflate the balloon with saline in the desired zone 
#*Resistance will be felt as the balloon inflates against the wall of the aorta and '''blood pressure will increase substantially if successful'''

==Complications==
*Failure to access the common femoral artery

==See Also==
*[[Thoracotomy]]
*[[Pericardial tamponade]]
*[[Thoracic trauma]]
*[[Abdominal trauma]]
*[[Arterial line]]

==External Links==
*[http://blog.ercast.org/reboa/ REBOA 101 ERCast]

===Videos===
{{#widget:YouTube|id=b-s2cpuHq9k}}

==References==
<references/>

[[Category:Procedures]]
[[Category:Critical Care]]
[[category:Trauma]]