Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Massive Torso Hemorrhage: Applications and Outcome in a Tertiary Care Center

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive image guided percutaneous technique for resuscitation and temporary hemostasis in critically ill patients, bleeding from the torso.

Purpose: To describe our initial experience and results using REBOA

Materials and Methods: A retrospective study of patients undergoing REBOA since 2018 at HUMC. Nine consecutive patients were identified from the unit logbooks and electronic patient record. REBOA was utilized in the setting of massive hemorrhage and (1) "non-responding" hemodynamic instability (systolic arterial blood pressure < 60 mm Hg), or (2) needing cardiopulmonary resuscitation. Image guidance included ultrasound +/- fluoroscopy, performed in the interventional radiology unit (IR), operating room (OR) or emergency department (ED). Recorded data included zone and duration of balloon inflation, change in hemodynamic parameters, short-term outcome and procedure related complications.

Results: Indications for REBOA included major trauma (n=5), post-partum hemorrhage (n=2), aorto-duodenal fistula (n=1) and upper gastrointestinal tumor hemorrhage (n=1).

Arterial access for over the wire insertion of the "Rescue®" balloon catheter and ancillary devices was via the right common femoral artery (n=4), left CFA (n=2) and bilateral (n=3). Aortic balloon inflation was in Zone 3 - 7 patients (64%), Zone 1 - 3 patients (27%), and Zone 2 - 1 patient (9%); including more than one zone in two. Average duration of balloon inflation was 24.7 min, range 3-50 minutes. The mean (S.D.) systolic blood pressure improved with REBOA in all patients, from 60(8.39) mmHg prior to aortic occlusion to 110(13.67) mmHg after aortic occlusion. Five patients survived. Four patients (Trauma -3, Tumor hemorrhage -1) died from complications relating to hemorrhage, MOF and underlying disease. There were no procedure related complications.

Concusion: REBOA appears to be a useful strategy in obtaining short term hemodynamic control in critically ill patients, thereby facilitating patient transport and definitive therapy.