Simon and Zaf talk about the practicalities of REBOA and discuss whether it's ready for prime time in the UK.
Introduction
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive technique designed to control hemorrhage in patients with life-threatening bleeding and offers a bridge to definitive surgical intervention. Here at St Emlyn’s, we are committed to exploring innovative solutions that enhance patient outcomes in emergency medicine. In this post, we delve into the essentials of REBOA, its clinical application, benefits, and challenges.
Understanding REBOA
REBOA involves the insertion of a balloon catheter into the aorta via the femoral artery. By inflating the balloon, we can occlude the aorta, thus controlling bleeding below the point of occlusion. This procedure is particularly useful in cases of non-compressible torso haemorrhage, where traditional methods of haemorrhage control are inadequate.
Indications and Contraindications
Indications:
Contraindications:
The Procedure
Preparation
Before performing REBOA, it is crucial to ensure that the patient is appropriately resuscitated and stabilized as much as possible. This includes securing the airway, ensuring adequate ventilation, and achieving initial hemodynamic stabilization.
Insertion and Inflation
Monitoring and Maintenance
Continuous monitoring of vital signs and catheter position is essential. The occlusion time should be minimized to reduce ischemic complications. Ideally, REBOA should serve as a bridge to definitive surgical intervention within 30-60 minutes.
Benefits and Challenges
Benefits
Challenges
Conclusion
REBOA represents a promising advancement in trauma care, offering a vital tool in the management of life-threatening haemorrhage, but it's utility in the Emergency Department is uncertain.
Further reading EMCrit guest post - the good, the bad, the ugly of the (original) Joint Statement https://emcrit.org/emcrit/good-bad-ugly-of-joint-statement-reboa/ Updated 2019 Joint Statement from the ACS-COT, ACEP, NAEMSP, and NAEMT: https://tsaco.bmj.com/content/4/1/e000376.info London Air Ambulance Prehospital REBOA Case series: https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(18)31110-9