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J Surg Res. 2019 Apr;236:247-258. doi: 10.1016/j.jss.2018.11.038. Epub 2018 Dec 21.

Large Animal Models of Proximal Aortic Balloon Occlusion in Traumatic Hemorrhage: Review and Identification of Knowledge Gaps Relevant to Expanded Use.

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Vascular Surgery Service, San Antonio Military Medical Center, Fort Sam Houston, Texas; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address:
United States Army Institute of Surgical Research, Fort Sam Houston, Texas.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, Madigan Army Medical Center, Fort Lewis, Washington.



The aim of this study was to review and summarize the large animal data on resuscitative endovascular balloon occlusion of the aorta (REBOA) for traumatic hemorrhage and identify knowledge gaps pertinent to the proposed broader use of the technique in prehospital situations.


A review of published large animal models of traumatic hemorrhage incorporating REBOA with a primary outcome of the effect of aortic occlusion was performed. Data were collected on experimental protocols, hemodynamic effects, resuscitation requirements, mortality, metabolic and tissue consequences of induced ischemia-reperfusion, and effects on hemorrhage volume and other injuries.


A limited number of REBOA studies exist, and there is variability in the species and size of animals used. Various controlled and uncontrolled hemorrhage protocols have been studied, and a number of balloon devices used. Hemodynamic effects of occlusion were consistent as were basic systemic physiological effects. Minimal study of the effects of partial aortic occlusion and hemodynamic and metabolic physiology distal to the balloon has been performed, and partial or complete occlusion times >90 min have not been studied.


Significant knowledge gaps exist, which are potentially relevant to the expanded use of REBOA. Investigation into the physiology of partial occlusion and the metabolic effects and potential mitigation strategies for large-scale ischemia and reperfusion are particularly needed.


Hemorrhage; REBOA; Resuscitative endovascular balloon occlusion of the aorta; Translational research; Trauma


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