Resuscitative Thoracotomy and Aortic Cross-Clamp and Resuscitative Endovascular Balloon Occlusion of the Aorta

Abstract

There are three methods of aortic occlusion; RTACC (resuscitative thoracotomy with aortic cross-clamp), abdominal aortic compression/occlusion after laparotomy, and REBOA. It is essential to understand the characteristics of each methods and use them appropriately according to the situation or in combination. RTACC is characterized by its rapidity and certainty, but highly invasive. Abdominal aortic compression/occlusion is beneficial because hemostasis after laparotomy can be performed simultaneusly. Advantages of REBOA compared to RTACC are minimaly-invasiveness and safety, and disadvantages are rapidity and certainty. However, it is not necessary to discuss the superiority or inferiority of RTACC and REBOA. The appropriate determination of a combination of these tactics will increase the range of strategies. In particular, RTACC should be performed promptly for impending cardiac arrest and early conversion to REBOA can be helpful regarding to prevention of hypothermia and reduction of chest wall bleeding (To "REBOA & RTACC" instead of "REBOA vs RTACC").

Advances in resuscitative endovascular balloon occlusion of the aorta (REBOA): a comprehensive review of the evolution, patient criteria, and technological innovations in trauma management

“…Harmonizing patient selection criteria for REBOA in trauma management An analysis of 10 recent studies of REBOA in trauma patients describing patient selection criteria found that most described similar criteria (Table 1) [3,[18][19][20][21][22][23][24][25][26]. A pivotal criterion uniformly identified across these articles is the manifestation of hypotension, characterized by a transient or insufficient response to resuscitative interventions.…”