A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 47; no. 1; pp. 57 - 69
• Main Authors: Vrancken, Suzanne M., Borger van der Burg, Boudewijn L. S., Vrancken, Paul J. E. M., Kock, Gert-Aldert H., Rasmussen, Todd E., Hoencamp, Rigo
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2021; Springer Nature B.V
• Subjects: Catheters; Coronary vessels; Critical Care Medicine; Emergency medical care; Emergency Medicine; Hemorrhage; Intensive; Medical equipment; Medicine; Medicine & Public Health; Review Article; Sports Medicine; Surgery; Surgical Orthopedics; Traumatic Surgery; Aortic occlusion balloon catheter; REBOA; Stiffness; Resuscitation
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-020-01382-5

Purpose
Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation.
Methods
We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device.
Results
Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda
®
-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty
®
-45 and LeMaitre
®
-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda
®
-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon
®
. ER-REBOA™, Fogarty
®
, LeMaitre
®
, REBOA Balloon
®
, and Rescue Balloon™ are provided with external length marks to assist blind positioning.
Conclusion
In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty
®
, and LeMaitre
®
, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50
®
has several features that facilitate use and reduce the risk of malplacement or vessel damage.