REBOA for remote damage control resuscitation and the race against time

The management of noncompressible haemorrhage (NCH) remains a critical challenge in trauma care, with early mortality rates persistently high despite advances in trauma systems. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a potential intervention to address severe haemorrhage in prehospital and hospital settings. This review examines the role of REBOA in remote damage control resuscitation, focusing on the 'golden hour' and the 'platinum 5 minutes' concepts that underscore the urgency of timely interventions.

Evidence from the UK-REBOA trial and related studies highlights the complexity of implementing REBOA in prehospital settings, emphasising the importance of early deployment, appropriate patient selection, and minimisation of delays. Technological innovations, including AI-assisted decision-making and automated partial REBOA systems, offer promising avenues for optimising REBOA's application. Furthermore, the concept of damage control prehospital care prioritises essential interventions tailored to individual patient needs, advocating for a streamlined approach to reduce on-scene time.

The integration of REBOA with advanced prehospital strategies holds the potential for reducing preventable deaths from traumatic haemorrhage, but further research is needed to refine protocols and enhance outcomes in this high-stakes domain.