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Updated: Jul 13, 2026
Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Systematic Review of REBOA Access Methods for Noncompressible Torso Hemorrhage Patients
Utpal Chandra Das1, Maria Antico2, Christopher Edwards1
1School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia; Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Australia; Quantitative Ultrasound Imaging at QUT (QUIQ), Brisbane, Australia.
Introduction:
Noncompressible torso hemorrhage (NCTH) is a leading cause of preventable trauma-related mortality. In cases when conventional external compression is ineffective for hemorrhage control, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed as an endovascular approach for temporary proximal aortic occlusion, enabling partial or complete control of bleeding. Successful REBOA deployment depends on timely and accurate common femoral artery (CFA) access; delays or repeated failed access attempts are associated with increased mortality. This systematic review aimed to identify the safest, fastest, and most effective CFA access technique for REBOA procedures in patients with NCTH.
Methods:
A systematic literature search was conducted across four major databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the key concepts: ultrasound, REBOA, NCTH, and CFA. Studies meeting predefined PICOS (population, intervention, comparator [or context], outcomes, and study design) criteria were included, and 22 studies were analyzed to compare CFA access techniques.
Results:
Ultrasound-guided CFA access consistently demonstrated superior performance compared with blind percutaneous and fluoroscopic techniques, showing improved speed, safety, and procedural feasibility, particularly in emergency, prehospital, and resource-limited settings. Across the 22 included studies, ultrasound-guided CFA access improved first-pass success compared with landmark techniques (55% first-pass success for landmark access). Landmark access required multiple attempts in 45% of cases. Ultrasound guidance reduced time to access by 1-6 min and up to 5-8 min in optimized workflows. Overall vascular complication rates were approximately 7%. Complication rates decreased from 9.2% to 5.5% with ultrasound guidance. The majority of contemporary studies used 7 Fr sheaths, which were associated with fewer access-related complications.
Conclusions:
Ultrasound-guided CFA access represents the most efficient and reliable approach for REBOA deployment in patients with NCTH. Broader adoption of this technique may facilitate more rapid intervention and improve outcomes in trauma care.
