A Modern Case Series of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in an Out-of-Hospital, Combat Casualty Care Setting

J Spec Oper Med. Spring 2017;17(1):1-8.

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to mitigate bleeding and sustain central aortic pressure in the setting of shock. The ER-REBOA™ catheter is a new REBOA technology, previously reported only in the setting of civilian trauma and injury care. The use of REBOA in an out-of-hospital setting has not been reported, to our knowledge.

Methods: We present a case series of wartime injured patients cared for by a US Air Force Special Operations Surgical Team at an austere location fewer than 3km (5-10 minutes' transport) from point of injury and 2 hours from the next highest environment of care-a Role 2 equivalent.

Results: In a 2-month period, four patients presented with torso gunshot or fragmentation wounds, hemoperitoneum, and class IV shock. Hand-held ultrasound was used to diagnose hemoperitoneum and facilitate 7Fr femoral sheath access. ER-REBOA balloons were positioned and inflated in the aorta (zone 1 [n = 3] and zone 3 [n = 1]) without radiography. In all cases, REBOA resulted in immediate normalization of blood pressure and allowed induction of anesthesia, initiation of whole-blood transfusion, damage control laparotomy, and attainment of surgical hemostasis (range of inflation time, 18-65 minutes). There were no access- or REBOArelated complications and all patients survived to achieve transport to the next echelon of care in stable condition.

Conclusion: To our knowledge, this is the first series to demonstrate the feasibility and effectiveness of REBOA in modern combat casualty care and the first to describe use of the ER-REBOA catheter. Use of this device by nonsurgeons and surgeons not specially trained in vascular surgery in the out-of-hospital setting is useful as a stabilizing and damage control adjunct, allowing time for resuscitation, laparotomy, and surgical hemostasis.

Publication types

  • Case Reports

MeSH terms

  • Aorta*
  • Balloon Occlusion / methods*
  • Blood Transfusion
  • Emergency Medical Services / methods*
  • Endovascular Procedures / methods*
  • Hemorrhage / diagnostic imaging
  • Hemorrhage / etiology
  • Hemorrhage / therapy*
  • Humans
  • Military Medicine*
  • Military Personnel
  • Resuscitation / methods
  • Surgery, Computer-Assisted
  • Ultrasonography
  • War-Related Injuries / diagnostic imaging
  • War-Related Injuries / therapy*
  • Wounds, Gunshot / complications
  • Wounds, Gunshot / diagnostic imaging
  • Wounds, Gunshot / therapy*