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Review
. 2021 Aug 1;91(2S Suppl 2):S56-S64.
doi: 10.1097/TA.0000000000003166.

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Sarah C Stokes  1 , Christina M Theodorou, Scott A Zakaluzny, Joseph J DuBose, Rachel M Russo
Affiliations
Review

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Sarah C Stokes et al. J Trauma Acute Care Surg. .

Abstract

Background: Noncompressible torso hemorrhage is a leading cause of preventable death on the battlefield. Intra-aortic balloon occlusion was first used in combat in the 1950s, but military use was rare before Operation Iraqi Freedom and Operation Enduring Freedom. During these wars, the combination of an increasing number of deployed vascular surgeons and a significant rise in deaths from hemorrhage resulted in novel adaptations of resuscitative endovascular balloon occlusion of the aorta (REBOA) technology, increasing its potential application in combat. We describe the background of REBOA development in response to a need for minimally invasive intervention for hemorrhage control and provide a detailed review of all published cases (n = 47) of REBOA use for combat casualties. The current limitations of REBOA are described, including distal ischemia and reperfusion injury, as well as ongoing research efforts to adapt REBOA for prolonged use in the austere setting.

Level of evidence: Level V.

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Conflict of interest statement

Conflicts of interest and source funding: The views expressed in this material are those of the authors, and do not reflect the official policy or position of the U.S. Government, the Department of Defense or the Department of the Air Force.

References

    1. Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, Mallett O, Zubko T, Oetjen-Gerdes L, Rasmussen TE, et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431–7. - PubMed
    1. HUGHES CW. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954;36(1):65–8. - PubMed
    1. Morrison JJ, Ross JD, Rasmussen TE, Midwinter MJ, Jansen JO. Resuscitative endovascular balloon occlusion of the aorta: a gap analysis of severely injured UK combat casualties. Shock. 2014;41(5):388–93. - PubMed
    1. Russo RM, Neff LP, Johnson MA, Williams TK. Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage. Shock. 2016;46(3 Suppl 1):12–9. - PMC - PubMed
    1. Abid M, Neff LP, Russo RM, Hoareau G, Williams TK, Grayson JK, DuBose JJ, Lendrum R, Johnson MA. Reperfusion repercussions: A review of the metabolic derangements following resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2020;89(2S Suppl 2):S39–S44. - PubMed