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World J Emerg Surg. 2018 Nov 21;13:54. doi: 10.1186/s13017-018-0213-2. eCollection 2018.

Three cases of resuscitative endovascular balloon occlusion of the aorta (REBOA) in austere pre-hospital environment-technical and methodological aspects.

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1Burn Unit, Queen Astrid Military Hospital, B-1120 Brussels, Belgium.
2Department of Trauma Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium.
3Department of Vascular Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium.
4175th Surgical Detachment, US Army, Fort Campbell, Kentucky, USA.



The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment.In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm.


Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2).


Systolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2.


ER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion.


Austere surgery; Partial REBOA; Pre-hospital; REBOA; Resuscitative endovascular balloon occlusion of the aorta; Shock; Trauma

Conflict of interest statement

Not applicable: due to austere environment and life-threatening injuries, no inform consent of the patients could be requested before treatment. Afterwards, patients were admitted in other MTF and were lost for follow-up.Not applicable, as explained here above.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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