Endovascular Balloon Occlusion of the Aorta

Question 1

What is REBOA , indications and algorithms are based on ?

Answer 1

-Proximal aortic control using REBOA

-the presence or absence of signs of life on admission

Question 2

Indications for REBOA

Answer 2

-Blunt trauma patients arriving with loss of vitals, with organized rhythm detected on an EKG or FAST

-Penetrating trauma who underwent CPR for less than 15 minutes with a potential source of bleeding in the abdomen/ pelvis/ extremity and absent devastating head injury

-In hemodynamically unstable patients with pelvic fractures and negative FAST/ DPA who have no evidence of significant thoracic bleeding or an aortic injury

Question 3

Contraindications to REBOA

Answer 3

-traumatic aortic injury
-hemorrhage proximal to zones of occlusion including areas of the neck, axilla, and superior mediastinum

REBOA is hazardous in traumatic brain injury, blunt cardiac, penetrating neck, or chest trauma

Question 4

Relative Contraindications

Answer 4

-elderly age (age > 70 years)
-PEA arrest longer than 10 minutes
-presence of terminal illness
-profound comorbidities.

Question 5

complications from femoral arterial cannulation

Answer 5

Thrombosis and distal embolization leading to limb ischemia

This risk increases with larger catheters and with the cannulation of smaller arteries.

Question 6

After Placing REBOA Check What ?

Answer 6

Assessment of distal limb perfusion after REBOA placement is important to identify and mitigate ischemic complications.

Question 7

How to Avoid Ischemia in Cannulation

Answer 7

Cannulation of the common femoral artery (CFA) rather than the SFA is a key step in avoiding ischemic complications

Question 8

Zones of REBOA

Answer 8

-Zone 1 extends from the left subclavian artery to the celiac artery.

-Zone 2 is between the celiac artery and the lowest renal artery

-Zone 3 extends from the lowest renal artery to the aortic bifurcation.

The balloon should never be inflated in zone 2 to avoid the occlusion of visceral vessels

The goal is to inflate the REBOA catheter in zone 1 or zone 3

Question 9

Zone 1 and 3 Corresponds to ?

Answer 9

zone 1 and zone 3 corresponds to the xiphoid process and the umbilicus, respectively

Question 10

How to check REBOA Position

Answer 10

imaging (x-ray or fluoroscopy) to ensure proper positioning of the catheter before balloon inflation

Question 11

When to Stop inflating the Balloon

Answer 11

The balloon is slowly inflated until the contralateral femoral pulse is lost

Question 12

Safe duration of complete aortic occlusion

Answer 12

is within 15 and 30 minutes for a balloon inflated in zones 1 and 3

Question 13

Rate Limiting Step for REBOA

Answer 13

obtaining safe and accurate CFA access

Question 14

Complications of REBOA

Answer 14

-femoral access complications include arterial disruption, dissection, pseudoaneurysms, hematoma, thromboembolism, extremity ischemia

-Aortoiliac injuries include intimal tear, dissection, thrombosis, and rupture, which may be fatal or cause limb loss

-Thrombus formation

It is crucial to check for Doppler signals after balloon deflation
angiography should be performed before sheath removal to evaluate for distal thromboembolism