S4E10: Intro to REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) - Bonus episode with Dr Andrew Neill
This time is always busy for our trainees with interview preparation so Leah took the opportunity to sit down with Dr Andrew Neill, consultant in Emergency and Intensive Care Medicine in the Mater Hospital to discuss the controversial topic of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta). They discuss the UK-REBOA trial and the evidence behind the technique and why we should be cautious about it's used in the Irish trauma system in particular.
An open sceptic
Dr Neill confesses to being an open sceptic on the topic of REBOA, but talks us through he thoughts and the evidence base behind it.
What is REBOA?
Put in simplest terms, REBOA is a wire passed through the femoral artery into the aorta, at which point the balloon is inflated to prevent bleeding distal to that site.
Temporary haemorrhage control
Part of the issue here relates to unclear indications for REBOAs use. Much of Leah and Dr Neill’s discussion focuses on the critical importance of good quality basic resuscitation before all else, and REBOA should not compromise that. We’ve all heard of distracting injuries, but have you heard of distracting interventions? REBOA is only a temporary measure that may buy you some time on the way to definitive haemorrhage control. Thus rapid access to emergency theatre or interventional radiology is going to be a key determinant of whether you consider REBOA as it is not definitive haemorrhage control.
The time the balloon can stay inflated is around 30mins, but this is quite an arbitrary number and individual patient factors will influence this, as well as an increase in risks as discussed below.
Risks
Dr Neill talks through the issues that he anticipates with REBOA.
Procedural risks
Placing a femoral line in an arrest isn’t quite the same as putting a sheath into an artery in a patient who is peri-arrest.
Ischemia to distal organs
Reperfusion injury
Leading to hyper-kalaemic cardiac arrest
Procedure performed at the cost of good quality basic resuscitation techniques
Performing REBOA on someone who didn’t actually need it
Balloon incorrectly placed
?CXR or echo pre balloon inflation to confirm position
The trials
The meme
Your thoughts
What are your thoughts on REBOA? Let us know in the comments and share your thoughts on socials!
