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AANA J. 2019 Feb;87(1):19-25.

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as an Option for Uncontrolled Hemorrhagic Shock: Current Best Practices and Anesthetic Implications.

Author information

1
is a staff nurse anesthetist at the University of Maryland R. Adams Cowley Shock Trauma Center in Baltimore, Maryland.
2
is a staff nurse anesthetist at the University of Maryland R. Adams Cowley Shock Trauma Center.

Abstract

Noncompressible torso hemorrhage is reported to be a leading cause of potentially preventable mortality in both civilian trauma victims and military combat casualties. This hemorrhage may come from venous, arterial, or additional combined sources in the chest, abdomen, pelvis, axilla, or groin regions. Aortic occlusion as an adjunct to strategies for trauma damage control can decrease the amount of bleeding distal to the occluded site and provide a time-sensitive opportunity for resuscitation and definitive hemorrhage control. Recently, resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a temporary hemorrhage control and resuscitation technique that has the advantage of being minimally invasive and may offer improved patient morbidity and mortality compared with the traditional emergency department thoracotomy. An overview of the history of REBOA and indications and contraindications for its use is provided. A placement strategy for this technology, which includes basic suggested insertion techniques and anatomical placement sites, is also provided. Additionally, device-related morbidity and mortality are addressed. Anesthetic implications in the perioperative period are reviewed in light of current best practices. Recommendations are given for future research aimed at refining and improving the care of seriously injured patients who may require this type of lifesaving treatment.

KEYWORDS:

Endovascular; REBOA; hemorrhage; hemorrhage control; trauma

PMID:
31587739

Conflict of interest statement

The authors have declared no financial relationships with any commercial entity related to the content of this article. The authors did not discuss off-label use within the article.

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