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Similarly, REBOA is an additional technique when used 6. Hughes CW. Use of an intra-aortic balloon catheter tampon-
in the correct patient at the correct time. ade for controlling intra-abdominal hemorrhage in man. Sur-
gery. 1954;36(1):65–68.
7. Morrison JJ, Ross JD, Rasmussen T, et al. Resuscitative en-
REBOA is an additional component in the overall resus- dovascular balloon occlusion of the aorta: a gap analysis of
citation of an acutely ill trauma patient. Blood-product severely injured UK combat casualties. Shock. 2014;41(5):
resuscitation, transexamic acid, packaging, warming, 388–393.
analgesia, airway management, and evacuation to surgi- 8. Stannard A, Eliason JL, Rasmussen TE. Resuscitative endo-
cal correction are all part of the overall management. vascular balloon occlusion of the aorta (REBOA) as an adjunct
for hemorrhage shock. J Trauma. 2011;71(6):1869–1872.
Appropriate resuscitation teamwork is mandatory; a 9. Gupta BK, Khaneja SC, Flores L, et al. The role of intra-
single operator attempting this procedure will likely aortic balloon occlusion in penetrating abdominal trauma. J
only lead to significant patient morbidity or mortality. Trauma. 1989;29(6):861–865.
10. Lendrum RA, Perkins ZB, Davies GE. A training package for
Translating this procedure, even as completed by Lon- zone III resuscitative endovascular balloon occlusion of the
aorta (REBOA). Scand J Trauma Resusc Emerg Med. 2014;
don HEMS in the civilian prehospital arena, to com- 22(suppl 1):P18.
bat applications should be done with care. It is the 11. Stannard A, Morrison JJ, Sharon DJ, et al. Morphometric
author’s opinion, as an emergency medicine physician analysis of torso arterial anatomy with implications for resus-
with multiple combat deployments and experience treat- citative aortic occlusion. J Trauma Acute Care Surg. 2013;75
(2 suppl 2):S169–S172.
ing patients throughout the full spectrum, from point 12. Joint Theater Trauma System Clinical Practice Guideline.
of injury to casualty evacuation, to trauma bay in all Resuscitative endovascular balloon occlusion of the aorta
environments—night time, mountainside, multiple air (REBOA) for hemorrhagic shock. 16 June 2014. http://www
frames—and receiving training at the London Trauma .usaisr.amedd.army.mil/cpgs/REBOA_for_Hemorrhagic
Conference, that this procedure should probably be _Shock_16Jun2014.pdf. Accessed 24 February 2017.
reserved for use by treatment teams comprising indi- 13. White JM, Cannon JW, Stannard A, et al. Endovascular bal-
loon occlusion of the aorta is superior to resuscitative thora-
viduals with extensive ultrasound, surgical, and central cotomy with aortic clamping a porcine model of hemorrhagic
venous access experience. Access to surgical control in shock. Surgery. 2011;150:400–409.
less than 1 hour is also required because this is a tem- 14. American College of Emergency Physicians. Policy Statement.
porizing measure to be used as part of perioperative Emergency ultrasound guidelines. October 2008. https://www
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sound/ACEP-2008-EUS-Guidelines.pdf. Accessed 24 Febru-
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Disclosures 15. Saito N, Matsumoto H, Yagi T, et al. Evaluation of the safety
and feasibility of resuscitative endovascular balloon occlusion
The author has nothing to disclose. of the aorta. J Trauma Acute Care Surg. 2015;78(5):897–904.
16. Stannard A, Morrison JJ, Scott DJ, et al. The epidemiology
of noncompressible torso hemorrhage in the wars in Iraq and
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17. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the bat-
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3. Kragh JF Jr, Walters TJ, Baer DG, et al. Practical use of emer- MAJ Knight, USA, is currently assigned to Womack Army
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4. Kragh JF Jr, Walters TJ, Baer DG, et al. Survival with emer- the Uniformed Services University of the Health Sciences
gency tourniquet use to stop bleeding in major limb trauma. (Bethesda, Maryland) in 2008 and completed his residency
Ann Surg. 2009;249:1–7. at Brooke Army Medical Center as an emergency department
5. Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on physician in 2011. He has deployed five times since 2012 in
the battlefield: causation and implications for improving com- various operational roles in support of Special Operations
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Forces. E-mail: ryan.m.knight8.mil@mail.mil.

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