The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
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REVIEW
Open Access
The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Marcelo A. F. Ribeiro Junior1*, Celia Y. D. Feng2, Alexander T. M. Nguyen2, Vinicius C. Rodrigues1, Giovana E. K. Bechara1, Raíssa Reis de-Moura1 and Megan Brenner3
Abstract Non-compressible torso hemorrhage (NCTH) remains a significant cause of morbidity and mortality in the field of trauma and emergency medicine. In recent times, there has been a resurgence in the adoption of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for patients who present with NCTH. Like all medical procedures, there are benefits and risks associated with the REBOA technique. However, in the case of REBOA, these complications are not unanimously agreed upon with varying viewpoints and studies. This article aims to review the current knowledge surrounding the complications of the REBOA technique at each step of its application. Keywords: Complications, Radiology, Interventional, Multiple trauma, Abdomen, Shock, Hemorrhagic, REBOA
Background Non-compressible torso hemorrhage (NCTH) is a major cause of morbidity and mortality in the trauma setting [1]. The difficulty in controlling NCTH arises from the fact that the bleeding cannot be managed like other types of traumatic hemorrhage, such as the use of tourniquets or direct pressure in limb hemorrhage [2, 3]. Instead, highly invasive techniques such as resuscitative thoracotomies (RT) are used to control thoracic bleeding. RT has low rates of patient survival as well as increased exposure of health care workers to blood-borne pathogens [4, 5]. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an old technique that has been receiving renewed interest in recent years [1, 6]. As the name suggests, the technique involves the introduction of a balloon occlusion catheter via the femoral artery into the aorta and inflating the balloon at one of two aortic zones (zone I or zone III) depending on the circumstances [7, 8]. The aorta can be divided into three zones (Fig. 1): with zone I being the aorta between the let subclavian artery and the celiac trunk, zone II being the aorta between the celiac trunk and the lowest renal artery, and zone III * Correspondence: [email protected] 1 Disciplina de Cirurgia Geral e Trauma, Universidade Santo Amaro, São Paulo, São Paulo, Brazil Full list of author information is available at the end of the article
being the area between the lowest renal artery and the aortic bifurcation [8]. Zone II is not for occlusion [8]. The balloon is then inflated to stem the flow of blood and later deflated and removed [8]. Renewed interest particularly in the USA in REBOA has led to its introduction in many trauma centers, as well as increased levels of research and analysis regarding the technique [9]. REBOA shows promise in improving the outcomes for patients with NCTH in comparison to RT. In a recent prospective study, there was no significant difference in overall mortality between patients undergoing RT and those
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