Practice Preferences using Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Injury Before and After the 2017 EndoVascular and Hybrid Trauma and Bleeding Management Symposium

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to aid in resuscitative efforts for hemorrhagic shock. The use of REBOA is not yet commonplace and there is little understanding of real-world practice patterns. The Endovascular and Hybrid Trauma and Bleeding Management Symposium is a large international conference specifically developed to discuss multidisciplinary, endovascular and hybrid approaches to hemorrhage management. We sought to evaluate provider opinions and practice patterns using REBOA for traumatic vascular injury before and after attending this conference.
 Methods: A detailed survey was completed by a variety of providers before and after the conference. The survey was composed of demographic information, and focused on practice patterns and opinions regarding the implementation of REBOA. 
 Results: We received 186 survey responses (99 pre, 87 post). There was increased perception of feasibility for REBOA in all settings, with the largest increase for pre-hospital and austere military environments (53.5% pre, 67.8% post and 59.6% pre, 73.6% post respectively). While there was no consensus on tolerable occlusion times and indications for utilization, most participants felt that partial REBOA was the most viable technique for prolonging the benefits of REBOA, and more participants came to this conclusion after attending the conference (62.2% pre, 81.6% post, p=0.006).
 Conclusions: REBOA is an exciting and important advancement in the management of life threatening hemorrhage, however its implementation has not been codified and there is much variation in practitioners’ understanding of its use. Continued investigation is needed to determine the appropriate indications, methods, and practical limitations of REBOA as a new hemorrhage management paradigm.