J.Jpn. Surg. Soc.. 120(3): 282-289, 2019

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Feature topic

RESUSCITATIVE ENDOVASCULAR BALLOON OCCLUSION OF THE AORTA

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct technique to control life-threatening hemorrhage. It provides rapid, less-invasive proximal inflow control of the aorta, improves blood pressure, and reduces hemorrhage. REBOA is now being rapidly and widely recognized as a part of the damage control strategy for patients with noncompressible torso hemorrhage to achieve definitive hemorrhage control. Compared with resuscitative thoracotomy with aortic cross clamp, REBOA has the same effect and is less invasive. In Japan, REBOA has been used as intraaortic balloon occlusion since the late 1990s. The main indication for REBOA use in trauma is hemorrhagic shock related to torso injury below the diaphragm (abdominal, pelvic, junctional). Cannulation is performed through the common femoral artery with the percutaneous Seldinger method or open cut-down, and a balloon is inflated in aortic zone 1 for abdominal or truncal hemorrhage and in zone 3 for pelvic or junctional hemorrhage. 7 Fr-sized REBOA has been available since 2013. More than 15-min occlusion causes ischemic organ damage, reperfusion injury, and lower extremity ischemia. After REBOA placement and balloon inflation, definitive hemostasis must be achieved as soon as possible, and the duration of occlusion time should be less than 30 min. High-grade evidence for REBOA indications, efficacy, and patient safety is expected.

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