Bringing REBOA Closer to the Point of Injury

Abstract

Congratulations to the authors for examining partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA) to mitigate distal ischemia, reduce hemorrhage, and potentially improve survival. The study is an excellent observational investigation highlighting challenges in the use of prehospital REBOA. 1 Bringing REBOA closer to the point of injury means initiating aortic occlusion (AO) farther from definitive hemostasis. This study demonstrated a mean time of 89 minutes from emergency medical services request to emergency d e p a r t m e nt a d m i s s i o n .REBOA could be performed en route rather than at the point of injury to reduce critical occlusion time. In addition, AO was performed in only 1 of 2 ways, percutaneous access with REBOA or resuscitative thoracotomy. Those who have credentials to perform resuscitative thoracotomy should be trained and capable of performing open femoral artery access. Training surgeons in femoral artery cutdown will maximize the potential for REBOA use and may improve outcomes in this population. Both procedures require significant investment in education, not only to perform the tasks effectively, but to do so in a challenging mobile environment.The rate of complications due to REBOA access is certainly high; however, they were managed appropriately without limb loss. The only amputations were completion procedures required due to extensive injury. The surgeons used a