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Front Vet Sci. 2019 Jun 19;6:197. doi: 10.3389/fvets.2019.00197. eCollection 2019.

Resuscitative Endovascular Balloon Occlusion of the Aorta: Review of the Literature and Applications to Veterinary Emergency and Critical Care.

Author information

1
Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Travis, CA, United States.
2
Department of Surgery, University of California Davis Medical Center, Sacramento, CA, United States.
3
Vascular Surgery, Derriford Hospital, Plymouth, United Kingdom.
4
Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
5
Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
6
Department of Vascular and Endovascular Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States.
7
Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, United States.

Abstract

While hemorrhagic shock might be the result of various conditions, hemorrhage control and resuscitation are the corner stone of patient management. Hemorrhage control can prove challenging in both the acute care and surgical settings, especially in the abdomen, where no direct pressure can be applied onto the source of bleeding. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising replacement to resuscitative thoracotomy (RT) for the management of non-compressible torso hemorrhage in human trauma patients. By inflating a balloon at specific levels (or zones) of the aorta to interrupt blood flow, hemorrhage below the level of the balloon can be controlled. While REBOA allows for hemorrhage control and augmentation of blood pressure cranial to the balloon, it also exposes caudal tissue beds to ischemia and the whole body to reperfusion injury. We aim to introduce the advantages of REBOA while reviewing known limitations. This review outlines a step-by-step approach to REBOA implementation, and discusses common challenges observed both in human patients and during translational large animal studies. Currently accepted and debated indications for REBOA in humans are discussed. Finally, we review possible applications for veterinary patients and how REBOA has the potential to be translated into clinical veterinary practice.

KEYWORDS:

endovascular trauma management; hemorrhage; non-compressible truncal hemorrhage; shock; trauma

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