Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as an adjunct procedure for non-compressible torso hemorrhage in patients with hemorrhagic shock. With appropriate indications, REBOA should be performed for resuscitation regardless of the physician’s specialty. Despite its effectiveness in traumatized patients with hemorrhagic shock, performing REBOA has been challenging due to physicians’ lack of experience. Even though training in endovascular skills is mandatory, many physicians cannot undergo sufficient training because of the limited number of endovascular simulation programs. Herein, we share simulation video clips, including those of a vascular circuit model for simulation; sheath preparation; long guidewire and balloon catheter preparation; ultrasound-guided arterial access; sheath insertion or upsizing; and balloon positioning, inflation, and migration. The aim of this study was to provide educational video clips to improve physicians’ endovascular skills for REBOA.

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• Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience
  Gyeongho Lee, Dong Hun Kim, Dae Sung Ma, Seok Won Lee, Yoonjung Heo, Hancheol Jo, Sung Wook Chang
  Journal of Chest Surgery.2023; 56(2): 108.     CrossRef
• Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
  Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
  European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495.     CrossRef

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• Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review
  Marcelo Augusto Fontenelle Ribeiro Junior, Salman M Salman, Sally M Al-Qaraghuli, Farah Makki, Riham A Abu Affan, Shahin Reza Mohseni, Megan Brenner
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• Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study
  Yoonjung Heo, Sung Wook Chang, Byungchul Yu, Byung Hee Kang, Pil Young Jung, Kyounghwan Kim, Dong Hun Kim
  Journal of Acute Care Surgery.2024; 14(1): 16.     CrossRef
• On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
  A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
  Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14.     CrossRef
• Editor's Choice – Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern?
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• Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
  Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
  European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495.     CrossRef
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  Ji Young Jang, Keum Soek Bae, Byung Hee Kang, Gil Jae Lee
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Citations to this article as recorded by  

• Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience
  Gyeongho Lee, Dong Hun Kim, Dae Sung Ma, Seok Won Lee, Yoonjung Heo, Hancheol Jo, Sung Wook Chang
  Journal of Chest Surgery.2023; 56(2): 108.     CrossRef
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  Journal of Trauma and Injury.2023; 36(1): 3.     CrossRef

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• On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
  A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
  Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14.     CrossRef

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely performed as an adjunct to resuscitation or bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It is a crucial adjunct for the maintenance of cerebral and coronary perfusion during resuscitation. However, in polytrauma patients with concomitant neurotrauma, such as traumatic brain injury (TBI) or spinal cord injury, the physiological effects of REBOA are unclear. In this report on REBOA performed in a clinical setting for polytrauma patients with spinal cord injury or TBI, the physiological effects of REBOA in neurotrauma are reviewed.

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• Resuscitative Endovascular Balloon Occlusion of Aorta Versus Aortic Cross-Clamping by Thoracotomy for Noncompressible Torso Hemorrhage: A Meta-Analysis
  Saad Khalid, Mahima Khatri, Mishal Shan Siddiqui, Jawad Ahmed
  Journal of Surgical Research.2022; 270: 252.     CrossRef
• REBOA as a bridge to brain CT in a patient with concomitant brain herniation and haemorrhagic shock - A case report
  Luca Bissoni, Emiliano Gamberini, Lorenzo Viola, Carlo Bergamini, Emanuele Russo, Giuliano Bolondi, Vanni Agnoletti
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• Transsplenic Ultrasound-Guided Balloon Positioning During a Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta: A Case Report
  Yoonjung Heo, Sung Wook Chang, Dong Hun Kim
  Journal of Acute Care Surgery.2022; 12(1): 34.     CrossRef
• Current Approaches to Resuscitative Endovascular Balloon Occlusion of the Aorta Use in Trauma and Obstetrics
  Linden O. Lee, Paul Potnuru, Christopher T. Stephens, Evan G. Pivalizza
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• Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm
  Michael W Parra, Carlos Alberto Ordoñez, David Mejia, Yaset Caicedo, Javier Mauricio Lobato, Oscar Javier Castro, Juan Alfonso Uribe, Fernando Velasquez
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Damage control surgery (DCS) is an abbreviated laparotomy procedure that focuses on controlling bleeding to limit the surgical insult. It has become the primary treatment modality for patients with exsanguinating truncal trauma. Herein, we present the case of a 47-year-old woman with liver, kidney, and superior mesenteric vein (SMV) injuries caused by a motor vehicle collision. The patient underwent DCS following resuscitative endovascular balloon occlusion of the aorta (REBOA). In this case report, we discuss the importance of priority setting in DCS for the treatment of multisystem damage of several abdominal organs, particularly when the patient has incurred a combination of major vascular injuries. We also discuss the implications of damage control of the SMV, perihepatic packing, and right-sided medial visceral rotation. Further understanding of DCS, along with REBOA as a novel resuscitation strategy, can facilitate the conversion of uniformly lethal abdominal injuries into rescuable injuries.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been increasingly used in recent years as a resuscitative adjunct for trauma patients with life-threatening non-compressible torso hemorrhage. By blocking the aorta temporarily with an inflated balloon, REBOA preserves cerebral and coronary perfusion while diminishing exsanguination below the balloon, thereby providing time for resuscitation and definitive bleeding control. When determining the occlusion zone during the REBOA procedure, factors such tortuosity of the aorta, co-occurring minor chest injuries, and the severity of shock must be considered, as well as the main injury site. This paper describes a case of high Zone I REBOA in an elderly patient with a tortuous aorta who had concomitant injuries of the chest and pelvis.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel technique to maintain proximal arterial pressure. It is important to locate the balloon catheter correctly in performing REBOA but it is inaccurate to check the catheter position by external measurement. Even if the position of the catheter is initially confirmed by X-ray, it is difficult to determine the location of the catheter that changes according to various situations. We performed REBOA under real-time fluoroscopy and could maintain the catheter in correct position under various situations.

The following key questions and recommendations are presented herein: when is airway intubation initiated in severe trauma? Airway intubation must be initiated in severe trauma patients with a GCS of 8 or lower (1B). Should rapid sequence intubation (RSI) be performed in trauma patients? RSI should be performed in trauma patients to secure the airway unless it is determined that securing the airway will be problematic (1B). What should be used as an induction drug for airway intubation? Ketamine or etomidate can be used as a sedative induction drug when RSI is being performed in a trauma patient (2B). If cervical spine damage is suspected, how is cervical protection achieved during airway intubation? When intubating a patient with a cervical spine injury, the extraction collar can be temporarily removed while the neck is fixed and protected manually (1C). What alternative method should be used if securing the airway fails more than three times? If three or more attempts to intubate the airway fail, other methods should be considered to secure the airway (1B). Should trauma patients maintain normal ventilation after intubation? It is recommended that trauma patients who have undergone airway intubation maintain normal ventilation rather than hyperventilation or hypoventilation (1C). When should resuscitative thoracotomy be considered for trauma patients? Resuscitative thoracotomy is recommended for trauma patients with penetrating injuries undergoing cardiac arrest or shock in the emergency room (1B).