REBOA: The Next Stop on the Road to Trauma Management?

The management of major trauma has a long history of failures found along a road of good intention. From Military Anti-Shock Trousers (MAST) to aggressive crystalloid administration, we’ve seen management strategies come and go over the years, after the reality of the practice didn’t measure up to the expectation of improved outcomes. Today, we have several novel concepts being implemented across the world to try to move the needle for trauma resuscitation. Tranexamic acid (TXA), blood product administration, and simple (finger) thoracostomy are a few of the advances that seem to be gaining interest in EMS. Although these developments are still “state of the art” practice in EMS, many are wondering what the next stop is on the road to trauma management. The next stop may be resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock with uncontrolled abdominal, pelvic, or lower extremity bleeding. What Is REBOA? The procedure involves first performing a chest X-ray to ensure that there’s no widened mediastinum indicating thoracic aortic dissection. Then a 7 cm French sheath is inserted into the femoral artery through ultrasound-guided percutaneous technique or cut-down. The REBOA catheter is then measured using landmarks for Zone 1 insertion to address abdominal hemorrhage, or Zone 3 insertion to address isolated pelvis or lower extremity hemorrhage. The balloon is introduced to the desired length and a second chest X-ray is performed to ...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Trauma Exclusive Articles Columns Source Type: news