A Contemporary Assessment of Devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): Resource-specific Options Per Level of Care

Overview

Journal Eur J Trauma Emerg Surg

Specialties Critical Care
Emergency Medicine

Date 2020 May 31

PMID 32472443

Citations 5

Authors

Suzanne M Vrancken

Boudewijn L S Borger van der Burg

Paul J E M Vrancken

Gert-Aldert H Kock

Todd E Rasmussen

Rigo Hoencamp

Affiliations

Soon will be listed here.

Abstract

Purpose: Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation.

Methods: We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device.

Results: Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty-45 and LeMaitre-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon. ER-REBOA™, Fogarty, LeMaitre, REBOA Balloon, and Rescue Balloon™ are provided with external length marks to assist blind positioning.

Conclusion: In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty, and LeMaitre, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50 has several features that facilitate use and reduce the risk of malplacement or vessel damage.

Citing Articles

Cushioned on the way up, controlled on the way down during resuscitative endovascular balloon occlusion of the aorta (REBOA): investigating a novel compliant balloon design for optimizing safe overinflation combined with partial REBOA ability.

Power A, Parekh A, Parry N, Moore L Trauma Surg Acute Care Open. 2022; 7(1):e000948.

PMID: 35949246 PMC: 9295662. DOI: 10.1136/tsaco-2022-000948.

Comparison of aortic zones for endovascular bleeding control: age and sex differences.

van der Burg B, Vrancken S, van Dongen T, Wamsteker T, Rasmussen T, Hoencamp R Eur J Trauma Emerg Surg. 2022; 48(6):4963-4969.

PMID: 35794255 PMC: 9712362. DOI: 10.1007/s00068-022-02033-7.

Aortosubpulmonary Fistula after Konno-Rastan Aortoventriculoplasty.

Mehta A, Wakefield B, Collier P, Kalahasti V, Grimm R, Najm H CASE (Phila). 2021; 5(5):292-300.

PMID: 34712873 PMC: 8530821. DOI: 10.1016/j.case.2021.07.009.

REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients.

Ordonez C, Parra M, Caicedo Y, Padilla N, Rodriguez-Holguin F, Serna J Colomb Med (Cali). 2021; 51(4):e4064506.

PMID: 33795901 PMC: 7968426. DOI: 10.25100/cm.v51i4.4422.4506.

Size matters: first-in-human study of a novel 4 French REBOA device.

Power A, Parekh A, Scallan O, Smith S, Novick T, Parry N Trauma Surg Acute Care Open. 2021; 6(1):e000617.

PMID: 33490605 PMC: 7798668. DOI: 10.1136/tsaco-2020-000617.

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