Thread by @CritCareReviews

1/13

➡️ REBOA is an exciting "new" therapy for non-compressible torso haemorrhage
➡️ It's used across the world, but without robust evidence
➡️ Does it work? Is it beneficial?
➡️ A thread...

2/13

🚩 Uncontrollable haemorrhage accounts for
 ➡️ > 80% of combat deaths
  ➡️ ~ 40% of civilian trauma-related deaths
🚩 Many have been determined to be preventable deaths
🚩 ~ 67% of fatal bleeding occurs in the torso region

3/13

Emergency thoracotomy (ET) has a long history in resuscitation

🚩 1880 - Paul Niehans first documented ET in human cardiac arrest
🚩 1901 - Kristian Ingelsrud performed the first successful resuscitation
🚩 1953 - Stephenson had 28% survival in 1200 cardiac arrests

4/13

🚩 1960s - the twin developments of closed chest cardiac massage & defibrillation lead to a decline in ET for cardiac arrest
🚩 But closed chest compressions were ineffective for trauma
🚩 1967 - Beall reported the re-use of ET for resuscitation, renewing interest in ET

5/13

🚩 REBOA was first described by American Lt. Col. Carl W. Hughes in 1954 during the Korean War
🚩 Aortic occlusion was with a Dotter-Lukas balloon
🚩 2 patients were treated & died, from multiple GSWs & grenade blast injuries
🚩 Hughes felt survival had been possible

6/13

🚩 REBOA indications

1⃣ traumatic life-threatening hemorrhage below the diaphragm in hemorrhagic shock patients unresponsive or transiently responsive to resuscitation
2⃣ patients in arrest from injury due to presumed life-threatening hemorrhage below the diaphragm

7/13

🚩 Procedure

REBOA is inserted using a Seldinger technique, either via

1⃣ surgical cut-down
2⃣ percutaneously with ultrasound

🔴 It is left in place for as short a time as possible

8/13

🚩 REBOA is placed in either zone 1 or 3

1⃣ Zone 1 - for any hemorrhages originating below the diaphragm & patients in cardiac arrest
2⃣ Zone 3 - for pelvic injuries with no evidence of intraabdominal bleeding

Zone 2 occludes visceral arteries and is rarely chosen

9/13

🚩 Complications

1⃣ Insertion - femoral artery injury, aortic dissection & perforation, embolisation, air embolism, peripheral ischaemia & balloon rupture
2⃣ Balloon inflation - organ ischaemia
3⃣ Balloon deflation - haemorrhage / reperfusion injury

10/13

🚩 Alternatives

1⃣ Thoracotomy / laparotomy (open aortic clamping)
2⃣ Pelvic binder
3⃣ Abdominal aortic & junctional tourniquet
4⃣ iTClamp
5⃣ Topical - Foams / Gels & Pastes / Sponges / Peptides
6⃣ Intravenous - particle-peptide conjugates / polymer-peptide conjugates

11/13

🚩 Is REBOA beneficial?

➡️ Only observational data at present

🔴 AORTA 1 study
➡️ Mortality (REBOA v Thoracotomy) 72% vs. 84%; P = 0.12
🟠 AORTA 2
➡️ Mortality 48% v. 93%, P <0.001 (if no CPR)
🟡 Japan Trauma Data Bank (2023)
➡️ Mortality 55.2% v 81.6%; P < 0.001

12/13

🚩 But does it actually work?

Join us in @TitanicBelfast to hear @janjansenuk & @MarionKCampbell present the results of the @UKREBOATrial, the first randomised controlled trial of REBOA

Critical Care Reviews Meeting 2023 #CCR23
June 14th - 16th
criticalcarereviews.com/meetings/ccr23

@TitanicBelfast @janjansenuk @MarionKCampbell @UKREBOATrial 13/13

If you want to know more about REBOA, check out our REBOA page, containing links to:

➡️ free narrative reviews
➡️ guidelines
➡️ the observational studies mentioned here

criticalcarereviews.com/therapies/reboa