Deployment of second-generation resuscitative endovascular balloon occlusion of the aorta for unresponsive hypotension in a polytrauma patient

Abstract

Noncompressible hemorrhagic control remains one of the most challenging areas in damage control medicine and continues to be a leading cause of preventable death. For decades, emergency thoracotomy or laparotomy and aortic cross clamping have remained the gold standard intervention. Recently, there has been a movement toward less invasive techniques for noncompressible hemorrhagic control, such as resuscitative endovascular balloon occlusion of the aorta (REBOA). The REBOA technique involves inflation of an endovascular balloon within the abdominal aorta proximal to the vascular injury to temporarily inhibit bleeding. Although the literature is robust on this new technique, skepticism remains about whether REBOA is superior to aortic cross clamping, as it has been associated with complications including organ and limb ischemia, limb amputation, femoral aneurysm, and thrombosis.

Fig. 1

Intraoperative blood pressure measurement in a 61-year-old man; systolic blood pressure (mm Hg) is plotted on the y axis and time on the x axis. Preoperative measurements were those taken in the trauma bay upon arrival. Arrow 1 is time of catheter insertion (16:08:15), arrow 2 is time of balloon inflation (16:09), and arrow 3 is time of balloon deflation (16:45), at which point the catheter was also removed. The sheath was left in place until postoperative day 1, at which point it was removed in the intensive care unit.

Fig. 2

Fluoroscopy image showing balloon deflation (white arrow) in zone 3. The inferior vena cava filter can be seen on the right (black arrow), in addition to pelvic packing material (dotted arrow).