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Updated: Jun 25, 2025
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
pREBOA versus ER-REBOA impact on blood utilization and resuscitation requirements: A pilot analysis
Courtney H Meyer1, Andrew Beckett, Bradley M Dennis
1From the Department of Surgery (C.H.M.), Emory University School of Medicine, Atlanta, Georgia; Grady Health System (C.H.M., J.N.), Atlanta, Georgia; Rollins School of Public Health (C.H.M.), Emory University, Atlanta, Georgia; Department of Surgery (A.B.), University of Alberta, Edmonton, Alberta, Canada; Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Department of Surgery (B.M.D.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Surgery (J.D.), Tulane School of Medicine Health Science Center, New Orleans, Louisiana; R Adams Cowley Shock Trauma Center (R.K.), University of Maryland, Baltimore, Maryland; Division of Trauma and Acute Care Surgery (U.P.), OhioHealth Grant Medical Center, Columbus, Ohio; Department of Surgery (R.L.), Orlando Regional Medical Center, Orlando, Florida; Shock Trauma Center at Denver Health (E.M.), Denver, Colorado; Division of Trauma and Acute Care Surgery (C.S.), Mount Carmel Health System, Columbus, Ohio; Department of Surgery (W.M.V.), Northeast Georgia Medical Center, Gainesville, Georgia; and Department of Surgery (J.N.), Morehouse School of Medicine, Atlanta, Georgia.
Background:
Partial occlusion of the aorta is a resuscitation technique designed to maximize proximal perfusion while allowing a graduated amount of distal flow to reduce the ischemic sequelae associated with complete aortic occlusion. The pREBOA-PRO catheter affords the ability to titrate perfusion as hemodynamics allows; however, the impact of this new technology for resuscitative endovascular balloon occlusion of the aorta (REBOA) on blood use and other resuscitative requirements is currently unknown. We hypothesize that patients undergoing REBOA with the pREBOA-PRO catheter will utilize partial occlusion, when appropriate, and decrease overall resuscitative requirements when compared to patients undergoing REBOA with the ER-REBOA catheter.
Methods:
The entire American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry was used to compare resuscitation requirements between all ER-REBOA and pREBOA. Unpaired t tests were used to compare resuscitation strategies including packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, cryoprecipitate, crystalloids, and need for pressors.
Results:
When comparing ER-REBOA (n = 800) use to pREBOA (n = 155), initial patient presentations were similar except for age (44 years vs. 40 years, p = 0.026) and rates of blunt injury (78.4% vs. 78.7% p < 0.010). Zone 1 occlusion was used less often in ER-REBOA (65.8 vs. 71.7, p = 0.046). Partial occlusion was performed in 85% of pREBOA compared with 11% in ER-REBOA ( p < 0.050). Vitals at the time of REBOA were worse in ER-REBOA and received significantly more units of PRBCs, FFP, platelets, and liters of crystalloids than pREBOA ( p < 0.05). Rates of ARDS and septic shock were lower in pREBOA ( p < 0.05).
Conclusion:
When comparing pREBOA to ER-REBOA, there has been a rise in Zone 1 and partial occlusion. In our pilot analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry, there was a reduction in administration of PRBCs, FFP, platelets, and crystalloids. Although further prospective studies are required, this is the first to demonstrate an association between pREBOA, partial occlusion, and reduced blood use and resuscitative requirements.
Level Of Evidence:
Therapeutic/Care Management; Level IV.
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