Written by Doug Wallace
Spoon Feed
REBOA, a technique for controlling non-compressible torso hemorrhage, is increasingly used in trauma centers — but carries major risks that require thoughtful utilization. Understanding indications, zones, and complications is key for any emergency provider practicing at a Trauma Center. See videos below.
Inflate responsibly
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a temporizing measure used to control bleeding by occluding the aorta and redirecting blood flow to vital organs. It’s primarily indicated for non-compressible torso hemorrhage in patients with signs of profound shock, particularly when other interventions (e.g., pelvic binding) are insufficient.
This review outlines the procedure’s key principles: REBOA is typically inserted via US guidance in the common femoral artery and advanced into one of two zones — Zone I (above the celiac trunk, ~48cm) for intra-abdominal hemorrhage, or Zone III (below the renal arteries, ~28cm) for pelvic bleeding. It’s contraindicated in thoracic bleeding and has significant risks, including vascular injury, limb ischemia, and potential delays to definitive surgical control. Total occlusion time should ideally be kept under 30–60 minutes to reduce ischemic complications.
Though mostly used by trauma or vascular surgeons, other service lines, including emergency physicians, are increasingly involved. Existing data are mixed in terms of efficacy and safety, and the procedure’s role continues to evolve.
How does this change my practice?
While most EM docs are not credentialed to initiate REBOA at my shop, I’ll know when to recognize potential candidates, communicate with trauma teams early, and respect that this balloon isn’t just another line — it’s a high-stakes bridge to definitive care.
Another Spoonful
See these educational REBOA videos that were recommended in the paper. Here is another video in a cadaver model.
Source
Resuscitative Endovascular Balloon Occlusion of the Aorta: What You Need to Know. J Trauma Acute Care Surg. 2025 Jun 1;98(6):831-839. doi: 10.1097/TA.0000000000004534. Epub 2025 Feb 19. PMID: 39969564
