Intra-Vascular Occlusion of the Aorta for Massive Pelvic Trauma: A New Application

Abstract

Globally, trauma remains the leading cause of morbidity and mortality for all age groups with uncontrolled hemorrhage as the most common form of preventable death in the trauma setting. Specifically, non-compressible torso hemorrhage in trauma patients is known to have high mortality rates. Open aortic cross clamping via anterolateral thoracotomy has been the standard approach, but the procedure carries a high mortality risk. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that promptly controls hemorrhage, increases cardiac afterload, and increases central aortic pressure. REBOA in different forms has existed since the Korean War in 1950. It involves the insertion of a balloon into the aorta via a femoral access approach that is subsequently inflated to provide hemostasis. Despite the potential of REBOA to save lives, many non-vascular surgeons and emergency healthcare providers may be reluctant to use the new procedure. This may be due to a lack of knowledge, skill, or equipment required to perform the procedure. We present a case of a patient with multiple pelvic injuries and massive bleeding for which REBOA was utilized safely and correctly.