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How This 60-Year-Old Trauma Procedure Could Save More Lives

January 24, 2016

As a Level One Trauma Center, we help people with severe injuries every day.

Our goal is to save lives and to do our best to help people resume life as they knew it before their accident or traumatic injury. In recent decades, we’ve made several advancements to accomplish this goal.

REBOA, or Resuscitative Endovascular Balloon Occlusion of the Aorta, is one procedure many doctors are now revisiting in an effort to improve trauma care. The technique involves using balloons to control internal bleeding. REBOA first emerged more than 60 years ago during the Korean War, when Lt. Col. Carl W. Hughes used a catheter and a 20 cc balloon on two soldiers. However, in subsequent years the technique did not gain more widespread acceptance. Now ongoing research, advancements in surgical technology and critical care have led more doctors to reassess how it can be used to improve outcomes.

Background on REBOA

We encounter several types of injuries when someone enters the emergency room after a trauma. Some people may experience hemorrhagic shock, which is when the body can’t properly function because it doesn’t have enough oxygen and nutrients. This shock can occur because of injuries to the chest, abdomen or pelvis. When this happens and we need emergent control of hemorrhage, we might perform a procedure called a thoracotomy for aortic compression, which involves making a incision in the chest cavity to resuscitate the person and control the bleeding.

However, REBOA is a less invasive technique that could be used in place of this procedure. It causes less disruption to the body’s normal functioning and has higher rates of technical success than established procedures like aortic cross clamping. With this technique, doctors can access the arteries through the common femoral artery, a large artery in the thigh that supplies much of the blood flow to the legs. They use a tool to insert a balloon catheter into the appropriate section of the aorta—the main artery in the human body—and then inflate the balloon so that it can stop the hemorrhage. Doctors can perform REBOA in different parts of the aorta depending on whether someone has an abdominal or pelvic injury.

Advancement in the Treatment of Traumatic Injuries

We’re now learning that REBOA may work well in specific types of trauma cases, including in people who experience low blood pressure after a trauma on the way to a trauma center or while in the hospital.

A 2011 study in the Journal of Trauma even showed that this technique could extend survival time and reduce the need for additional fluids to replace blood loss. Another 2012 study showed that REBOA was effective in controlling blood loss after a pelvic injury, and a 2013 study showed promising results in six critically ill trauma patients.

Throughout all these studies, we’ve learned that REBOA works and that skilled acute care surgeons effectively can perform this technique. In the future, those in the medical community hope REBOA can become even less invasive, that there will be more formalized training for this technique, and that we will eventually get to a place where REBOA can be used in the field before patients are transported the hospital.

We still have some work to do to achieve these milestones, but it’s encouraging that many doctors and researchers are now revisiting this procedure. Medicine is constantly evolving and sometimes we have to give things a second look. In this case, doing so could potentially save more lives.