Reboa

resuscitative balloon occlusion of aorta in trauma

1. Resuscitative balloon occlusion of the aorta (REBOA) Fathi Abshina Trauma Center GSH

2. D efinition REBOA is one of the Endovascular methods for aortic control in torso hemorrhage, because the last one still a leading cause of preventable death (massive pelvic and abdominal hemorrhage . The earliest reported use of aortic balloon occlusion in trauma was during the Korean War, where a balloon catheter was inserted via the femoral artery into the thoracic aorta in two patients with abdominal bleeding. Although neither patient survived deflation of the balloon. The first pre-hospital use of REBOA was performed by London air ambulance

3. Physiology   In patients with hypovolemia , aortic occlusion (open or endovascular) can restore blood pressure to within normal physiological values (at least temporarily) by increasing cardiac afterload, thereby increasing cerebral and myocardial perfusion.

4. Potential Indication Pelvic trauma with shock Torso trauma at risk of hemorrhagic shock Non Traumatic such as ruptured abdominal aortic aneurysm (AAA). 

5. Contraindications   Patients who are not candidates for resuscitative thoracotomy should not be considered for REBOA at this time. Furthermore , patients with penetrating thoracic trauma or evidence of thoracic hemorrhage should not undergo REBOA . A relative contraindication to REBOA is inability to obtain femoral vascular access .

6. REBOA Technique There are five fundamental steps in the resuscitative endovascular balloon occlusion of the aorta (REBOA) procedure: Arterial access S heath placement B alloon catheter insertion B alloon inflation Deflation Sheath removal

7. Essential equipment for REBOA placement Timing of placement within 2 h

8. Aortic Anatomy And Zones Three functional zones for balloon placement: Zone I extends from the left sub- clavian artery to the celiac trunk, and occlusion in this region will control inflow to the abdominal viscera as well as to the pelvis and lower extremities. Zone II lies between the celiac trunk and the lowest renal artery and has traditionally been considered a zone of no occlusion, although the consequences of Zone II occlusion have not been specifically assessed. Zone III is comprised of the infrarenal aorta, and occlusion in this region controls pelvic and lower extremity inflow.

9. Complications The risks associated with REBOA are poorly defined. Since most patients do not have autopsy, it may be difficult to identify injuries attributable to REBOA . Reported complications from REBOA include arterial injury at the access site or the aorta, thromboembolic complications from the balloon and/or sheath, and end-organ failure.

10. Outcomes   Data for the outcomes of resuscitative endovascular balloon occlusion (REBOA) are limited.

11. On going challenging: Complete or incomplete occlusion Balloon pressure I deal timing of REBOA placement Zone I REBOA

12. Conclusion REBOA is preferred and less invasive than resuscitative thoracotomy but still more researches are recommended in this field.

13. Future of intervention therapy of trauma