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Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a device that was created to assist in hemorrhage control in resuscitative trauma surgery where a tourniquet or other direct pressure is not possible. It is placed via a sheath in the femoral artery. To prevent ischemic injury, occlusion time should be kept to a minimum. In a joint statement (see References), four national emergency and trauma medicine organizations recommended that occlusion time in Zone 1 (see photo: Zones 1-3) be limited to a maximum of 15 minutes. Additionally, thorough assessment of lower extremity perfusion should be done before, during, and after occlusion. For Zone 3, occlusion time should be limited to a maximum of 30 minutes. Much of the utilization of the REBOA has been in a deployed military setting, such as the US Air Force's Special Operations Surgical Teams (SOST), but is not necessarily translatable, directly, to a civilian setting. There are only a small number of trauma centers in the US that are capable of utilizing the REBOA. Its use is limited to physician-led teams where definitive hemorrhagic control (i.e. resuscitative trauma surgical intervention) is immediately available.

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-Potential for providing valuable time for hemorrhagic control in non-compressible trauma below the diaphragm
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It seems counterintuitive to ever think about occluding the aorta, the vessel that gives rise to all other vessels supplying oxygenated blood to the majority of the body. However, in the case of traumatic hemorrhage where a tourniquet or direct pressure is not an option, this device could provide a potential solution. While the risks and difficulties are many and great, there is also the possibility that a great many lives could be saved once this technology is better understood and utilized. Open heart surgery was once thought to be impossible, and now lives are saved every day in operating rooms around the world. More evidence and practical experience is needed, however, in order to realize the full potential of this device. As mentioned in the summary section, the deployed military setting is an environment that has employed this device, and is in fact how I learned of its existence. As a former ICU nurse in the US Air Force, I have two friends that currently serve on AF Special Operations Surgical Teams, which consist of the following:

Emergency physician

General surgeon

Nurse anesthetist

Critical care nurse

Surgical technician

Respiratory therapist

These teams are positioned in far-forward battlefield locations, as close to potential mass casualty events without compromising their safety or location. These locations are usually quite remote and austere, and their purpose is to provide resuscitative trauma stabilization and transfer to a higher echelon of care. In these circumstances, REBOA could assist to provide definitive hemorrhagic control prior to transfer. If this device could save the lives of American soldiers, then it is worth further study. These lessons could then be applied to the civilian setting to save even more lives.

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Bulger, E. M., Perina, D. G., Qasim, Z., Beldowicz, B., Brenner, M., Guyette, F., Rowe, D., Kang, C. S., Gurney, J., DuBose, J., Joseph, B., Lyon, R., Kaups, K., Friedman, V. E., Eastridge, B., & Stewart, R. (2019). Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians. Trauma surgery & acute care open, 4(1), e000376. https://doi.org/10.1136/tsaco-2019-000376

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Zones 1-3

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-Ability to obtain vascular access could be compromised in patients that are hypovolemic
-Unintended balloon inflation in smaller vessels could cause damage
-Placement verification could take valuable time from hemorrhagic control interventions
-Balloon rupture could cause damage
-Prolonged aortic occlusion could lead to significant organ and/or tissue damage
-Reperfusion injury could lead to multi-system organ failure
-Based on the current data, there is no evidence that REBOA improves outcomes over standard treatment of severe traumatic hemorrhage

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1. Alice – Achiever: her drive to succeed can motivate the team to accomplish the task
2. Amelia – Adaptability: as things never go according to plan, she can help to "right the ship" when things get off track
3. Daisy – Developer: she can help to guide the ideas of the team in a productive manner
4. Isabelle – Includer: on a team, it is natural for dominant personalities to emerge; Isabell can help ensure everyone's voice is heard
5. Carter – Communication: communication is the most important aspect of a team, and he can help ensure everyone is on the same page

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1. Learner: I love to learn, and specifically the process of gathering and processing new information
2. Intellection: I love the process of intellectual exploration, of pondering meaning and finding beauty in the details
3. Analytical: I love to find patterns and reasons why things happen
4. Input: I have many interests, and I am curious about a wide variety of subjects
5. Discipline: I prefer order, routine, and structure