Resuscitative Endovascular Balloon Occlusion in Trauma Care

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emergent intervention designed to temporarily control life-threatening haemorrhage in patients with non-compressible torso injuries. By advancing a deflated balloon catheter via a femoral arterial access point into the descending aorta and inflating it at a chosen anatomical level, clinicians can arrest distal blood loss and maintain central perfusion to vital organs. Initially conceived as a less invasive alternative to open thoracotomy and aortic cross-clamping, REBOA has gained traction in both civilian and military settings. Its principal advantage lies in rapid haemodynamic stabilisation, creating a bridge to definitive surgical or endovascular repair. Over the past decade, refinements in catheter design, imaging guidance and training protocols have facilitated wider adoption. Nonetheless, the technique carries inherent risks, including ischaemia–reperfusion injury, vascular complications and organ dysfunction attributable to prolonged aortic occlusion. Current research seeks to define optimal occlusion durations, zone selection strategies and adjunctive therapies to mitigate collateral injury. As expertise expands, REBOA is increasingly integrated into hybrid operating theatres and prehospital care pathways, underscoring its global relevance in modern trauma systems.

Research from Nature Portfolio

Recent experimental work has investigated adjunct pharmacological approaches to reduce ischaemia–reperfusion injury following balloon deflation. In a large-animal haemorrhagic shock model, administration of a mitochondria-protective peptide during prolonged aortic occlusion resulted in lower fluid and vasopressor requirements, reduced biomarkers of renal and cardiac injury and attenuated inflammatory cytokine release. These findings illuminate the pathophysiological consequences of distal ischaemia and suggest that targeted mitochondrial rescue may enhance the safety profile of REBOA, particularly when occlusion times approach or exceed 30–45 minutes. Such translational studies pave the way for combined device-drug strategies aimed at improving outcomes in patients who require extended aortic control.

Resuscitative Endovascular Balloon Occlusion in Trauma Care publication trend

The graph below shows the total number of articles in resuscitative endovascular balloon occlusion in trauma care across all publications each year (not limited to Nature Index journals).

Technical terms

Resuscitative endovascular balloon occlusion of the aorta (REBOA): A catheter-based technique in which an intravascular balloon is inflated in the aorta to control bleeding below the level of occlusion and preserve central circulation.

Aortic occlusion zones: Anatomical segments of the aorta used to guide balloon placement—Zone I (descending thoracic aorta), Zone II (paravisceral segment) and Zone III (infrarenal aorta)—each selected based on injury location.

Haemorrhagic shock: A life-threatening condition characterised by inadequate tissue perfusion due to severe blood loss, leading to organ dysfunction.

Ischaemia–reperfusion injury: Tissue damage caused when blood flow is restored after a period of ischaemia, triggering oxidative stress and inflammatory cascades.

Hybrid operating theatre: A surgical suite equipped for both open and image-guided endovascular procedures, enabling rapid transition between modalities.

References

1. A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients. World Journal of Emergency Surgery (2017).
2. The complications associated with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). World Journal of Emergency Surgery (2018).
3. Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (2016).
4. Elamipretide mitigates ischemia-reperfusion injury in a swine model of hemorrhagic shock. Scientific Reports (2023).
5. Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study. World Journal of Emergency Surgery (2024).
6. A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination. European Journal of Trauma and Emergency Surgery (2018).