REBOA

Conceptualised as a tourniquet for the trunk - indicated where rapid proximal control of truncal haemorrhage would be lifesaving.

Indications:

• Traumatic cardiac arrest:
  • Penetrating abdo/pelvis trauma and severe haemorrhage below the diaphragm
  • Blunt trauma in the absence of significant PTX/HTX/cardiac tamponade
• Trauma and shock (SBP < 90mmHg)
  • If evidence of truncal haemorrhage, and no/transient response to blood, and no thoracic cause for shock (PTX/HTX/cardiac tamponade)

Contraindications

• Not candidates for aggressive resuscitation (e.g. no pulse for >15 minutes or obvious non-survivable injury)
• Non-truncal bleeding, unless direct control is achieved prior to occlusion
• Widened mediastinum on CXR in moderate to severe blunt force injury, where aortic injury is suspected (balloon could increase pressure and cause rupture)

Scenarios where it is useful:

• Temporising abdominal bleeding while mobilising hospital resources (OT or angio)
• Temporising pelvic bleeding (not responding to blood and binder) while mobilising angio

Risks

• Femoral artery injury - distal embolisation leading to limb ischaemia
  • Very important to document limb perfusion post-REBOA insertion
  • If any concerns, get CT angio immediately/discuss with vascular
• Placement in IVC - makes things worse by limiting preload

Placement

• Access CFA - the hardest and slowest part - should be started before really knowing whether we are going ahead with REBOA