In-Theater Assessment of Resuscitative Balloon Occlusion of the Aorta (REBOA) Capabilities and Training

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an endovascular technology indi-cated for temporarily controlling traumatic life-threatening, noncompressible abdominal, truncal, or pelvic hemorrhage. Through percutaneous access or cut-down to the femoral artery, an intra-aortic balloon catheter is fed into the aorta and inflated, occluding distal blood flow and, thus, bleeding. To determine specific barriers to REBOA in deployed environments, we conducted a quality improvement project and survey of ER-REBOA® placement and monitoring capabilities at four medical treatment locations in Iraq and Kuwait during the spring of 2019.

The primary objective was to evaluate each in-theater medical site's ability to deploy REBOA, which was defined as having a provider capable of placing REBOA and the minimum equipment necessary. The investigators interviewed providers and through self-reported surveys, determined the personnel capable of placing a REBOA. REBOA equipment and monitoring equipment were identified through direct inspection of sites and interviews with logistical and equipment staff.

A total of 113 individuals participated in the evaluation and training. Three of the four sites had the minimum training and equipment requirements to complete the procedure: one REBOA-capable provider, an unexpired ER-REBOA® device, and an unexpired introducer catheter kit. Overall, 6 out of 32 physicians (18.7%) were capable of placing an ER-REBOA.

This deployed site survey demonstrates that the minimal requirements and personnel for ER-REBOA placement were met at most studied locations in 2019. However, improvements in pre-deployment training of select medical personnel in REBOA and arterial blood pressure monitoring are recommended to ensure adequate resourcing and redundancy in training.