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Guidelines/Algorithms
Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
  1. Megan Brenner1,
  2. Eileen M Bulger2,
  3. Debra G Perina3,
  4. Sharon Henry1,
  5. Christopher S Kang4,
  6. Michael F Rotondo5,
  7. Michael C Chang6,
  8. Leonard J Weireter7,
  9. Michael Coburn8,
  10. Robert J Winchell9,
  11. Ronald M Stewart10
  1. 1Department of Surgery, R Adams Cowley Shock Trauma Medical Center, University of Maryland Medical System, Baltimore, Maryland, USA
  2. 2Department of Surgery, UW Medicine Harborview Medical Center, Seattle, Washington, USA
  3. 3Department of Emergency Medicine, University of Virginia, Charlottesville, Virginia, USA
  4. 4Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
  5. 5Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
  6. 6Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
  7. 7Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
  8. 8Department of Urology, Baylor College of Medicine, Houston, Texas, USA
  9. 9Department of Surgery, New York-Presbyterian Weill Cornell Medicine, New York, New York, USA
  10. 10Department of Surgery, UT Health San Antonio, San Antonio, Texas, USA
  1. Correspondence to Dr Ronald M Stewart, Department of Surgery, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA ; stewartr{at}uthscsa.edu

https://doi.org/10.1136/tsaco-2017-000154

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    Introduction 

    Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) provides a new tool in selected patients for the management of non-compressible torso hemorrhage.1–3 Recent improvements in technology have facilitated more rapid placement through smaller femoral access sheaths, which may reduce access-related complications.4 However, high grade evidence to guide REBOA use is limited, and there is a substantial complication risk should this approach be used inappropriately.5 To address the current state of implementation of this new therapeutic strategy, the American College of Surgeons Committee on Trauma (ACS COT) has worked in collaboration with the American College of Emergency Physicians to issue this joint policy statement which addresses the current practice relevant to patient indications, potential complications, implementation, patient management, and training of providers. We urge trauma centers to consider these factors in the adoption of this approach.

    General observations

    • No current, high-grade evidence clearly demonstrates REBOA improves outcomes or survival compared to standard treatment of severe hemorrhage.5–10

    • REBOA is less invasive than resuscitative thoracotomy and in skilled hands may be more rapidly applied as compared with resuscitative thoracotomy.

    • Acute care surgeons can learn and safely perform REBOA after a formal training course.9

    • REBOA is currently standard practice for select patients at a small number of trauma centers where surgeons are immediately available for the management of REBOA.2 6

    • The major rate-limiting step to REBOA is the ability to safely and efficiently cannulate the common femoral artery (CFA) in a hypovolemic patient.5 10–12 If percutaneous cannulation is not possible, surgical cut down is required.

    Indications for REBOA

    • REBOA is indicated for traumatic life-threatening hemorrhage below the diaphragm in patients in hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

    • REBOA is indicated for patients arriving in …

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