Revisiting the promise, practice, and progress of Resuscitative Endovascular Balloon Occlusion of the Aorta
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Accepted version
Embargoed until: 2024-09-27
Embargoed until: 2024-09-27
Publisher
Journal
Current Opinion in Critical Care
ISSN
1531-7072
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Show full item recordAbstract
Purpose of review The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to temporarily control bleeding and improve central perfusion in critically injured trauma patients remains a controversial topic. In the last decade select trauma services around the world have gained experience with REBOA. We discuss the recent observational data together with the initial results of the first randomised control trial and provide a view on the next steps for REBOA in trauma resuscitation Recent findings While the observational data continues to be conflicting, the first randomised control trial signals that in the UK, in-hospital REBOA is associated with harm. Likely a result of delays to haemorrhage control, views are again split on whether to abandon complex interventions in bleeding trauma patients and to only prioritise transfer to the operating room or to push REBOA earlier into the post injury phase, recognising that some patients will not survive without intervention. Summary Better understanding of cardiac shock physiology provides a new lens in which to evaluate REBOA through. Patient selection remains a huge challenge. Invasive blood pressure monitoring, combined with machine learning aided decision support may assist clinicians and their patients in the future. The use of REBOA should not delay definitive haemorrhage control in those patients without impending cardiac arrest