REBOA Use in a Medicalized Prehospital Setting Proposal for a First Protocol Based on the Delphi Method

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Vascular Surgery

Background:

• Resuscitative endovascular balloon occlusion of the aorta (REBOA) is vital for controlling severe hemorrhage.
• No established protocols exist for REBOA use in France's prehospital emergency system.
• A Delphi study was conducted to define REBOA indications and contraindications.

Purpose of the Study:

• To develop a protocol for REBOA application in a medicalized prehospital setting.
• To clarify indications and contraindications for REBOA in prehospital trauma care.
• To address gaps in current literature regarding REBOA use.

Main Methods:

• A three-round Delphi study involving international REBOA experts.
• 21 experts participated, addressing 10 literature-gaps.
• Consensus was reached on key questions regarding REBOA use.

Main Results:

• Consensus achieved on 10 critical questions regarding REBOA.
• REBOA is indicated for hemodynamically unstable, hemorrhaging patients unresponsive to norepinephrine.
• Maximum occlusion time for zone 1 REBOA in prehospital settings is approximately 30 minutes, with partial/intermittent occlusion preferred.

Conclusions:

• A protocol for prehospital REBOA use is proposed.
• Hemorrhagic shock unresponsive to high-dose norepinephrine warrants REBOA before transport.
• Zone 1 REBOA should be limited to 30 minutes, utilizing partial occlusion when feasible. Protocol requires updates based on clinical feedback and studies.