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Updated: Jul 29, 2025
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Titratable partial aortic occlusion: Extending Zone I endovascular occlusion times
David Gomez1, Asad Naveed, Joao Rezende
1From the Division of General Surgery (D.G., J.R., A.B.), St. Michael's Hospital, and Li Ka Shing Knowledge Institute (D.G., A.N., J.R., A.B.), Unity Health Toronto; Department of Surgery (D.G., J.R., A.B.), Temetry Faculty of Medicine, and Institute of Health Policy, Management and Evaluation (D.G.), University of Toronto, Toronto, Ontario, Canada; Division of Acute Care Surgery (B.M.D.), Vanderbilt University Medical Center, Nashville, Tennessee; Program in Trauma (R.K.), R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland; Division of Acute Care Surgery (E.B.), Grady Memorial Hospital, Atlanta, Georgia; Ernest E Moore Shock Trauma Center at Denver Health (R.L., E.E.M.), University of Colorado Denver, Denver, Colorado; Department of Surgery (J.N.), Morehouse School of Medicine, Atlanta, Georgia; Norman McSwain Trauma Center (J.D.), Tulane Acute Care Surgery, New Orleans, Louisiana; Division of Trauma and Acute Care Surgery (C.S., S.D.), Grant Medical Center, Columbus, Ohio; and Prytime Medical Devices (C.V.S.), San Antonio, Texas.
Novel devices enabling partial aortic occlusion extend resuscitation times for noncompressible torso hemorrhage (NCTH) on the battlefield. This advance is crucial for managing NCTH, a leading cause of death in combat casualties.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Vascular Surgery
Background:
- Noncompressible torso hemorrhage (NCTH) is a leading cause of death in combat casualties.
- Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for NCTH, but prolonged complete occlusion risks ischemia.
- Novel devices may allow extended zone 1 REBOA through partial occlusion.
Purpose of the Study:
- To describe zone 1 REBOA deployment characteristics using novel partial occlusion devices.
- To compare occlusion times between complete and partial aortic occlusion techniques.
Main Methods:
- Cross-sectional analysis of pREBOA-PRO data from 7 US/Canadian trauma centers (March 2021-June 2022).
- Included adult patients with successful zone 1 REBOA (2013-2022) from the AORTA registry.
- Compared occlusion patterns and durations between complete and partial occlusion groups.
Main Results:
- 122 patients included; 89 (73%) had zone 1 deployment.
- Median zone 1 total occlusion time was 40 minutes (IQR 25-74).
- Partial occlusion (76% of total time) was used in 42% of zone 1 cases, with longer total occlusion times observed compared to complete occlusion.
Conclusions:
- Titratable partial aortic occlusion enables longer zone 1 REBOA times.
- This technology may improve outcomes for combat casualties with NCTH by extending time to hemorrhage control.
- Feasibility of controlled partial occlusion is key to extending safe aortic occlusion durations.
