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surgeon reviewed the operative records, thus increasing the 2. Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on
potential for unintended bias. trauma outcome: an overview of epidemiology, clinical pre-
sentations, and therapeutic considerations. J Trauma. 2006;
As with all novel interventions, the risk versus benefit of each 60(6):S3–S11.
method is not yet fully evident. ResQFoam is not yet FDA 3. Kauvar DS, Wade CE. The epidemiology and modern man-
cleared for clinical use, REBOA is still in its infancy, and the agement of traumatic hemorrhage: US and international per-
spectives. Crit Care. 2005;9(5):S1–S9.
AAJTis seldom used. As a result, robust data on the true bene- 4. Joint Committee to Create a National Policy to Enhance Sur-
fit or harm of these devices are not yet available. Two ongoing vivability From Intentional Mass Casualty Shooting Events.
REBOA studies and a soon-to-start ResQfoam study aim to Improving survival from active shooter events: the Hartford
shed light on the optimal usage and safety of these devices. Consensus. Bull Am Coll Surg. 2013;98(6):14–16.
5. Joint Committee to Create a National Policy to Enhance Sur-
The study may have underestimated the potential benefit of vivability From Intentional Mass Casualty Shooting Events.
these hemorrhage control methods. First, it only included pa- Active Shooter and Intentional Mass-Casualty Events: The
tients who lived long enough to receive a laparotomy. Patients Hartford Consensus II. American College of Surgeons; 2013.
with hemorrhage that could have potentially been controlled 6. Jacobs LM; Joint Committee to Create a National Policy to
by one of these techniques may not have survived long enough Enhance Survivability From Intentional Mass Casualty Shoot-
to reach the operating room in order to meet our inclusion ing Events. The Hartford Consensus III: Implementation of
Bleeding Control. American College of Surgeons; 2015.
criteria. It is in those patients that these hemorrhage control 7. Morrison JJ, Rasmussen TE. Noncompressible torso hemor-
methods could have the biggest impact on outcome. Second, rhage: a review with contemporary definitions and manage-
patients who were treated with IR embolization, including ment strategies. Surg Clin North Am. 2012;92(4):843–858.
those hemorrhaging from pelvic fractures and solid organ 8. Harvin JA, Maxim T, Inaba K, et al. Mortality after emer-
(spleen, liver, and kidney) injuries, who did not also receive a gent trauma laparotomy: a multicenter, retrospective study. J
laparotomy, were not included. The hemorrhage control meth- Trauma Acute Care Surg. 2017;83(3):464–468.
ods discussed could be of potential benefit in patients with 9. Undurraga Perl VJ, Leroux B, Cook MR, et al. Damage-
these injuries that do not necessarily warrant laparotomy. control resuscitation and emergency laparotomy: findings from
the PROPPR study. J Trauma Acute Care Surg. 2016;80(4):
568–574.
Conclusion 10. Clarke JR, Trooskin SZ, Doshi PJ, et al. Time to laparotomy
for intra-abdominal bleeding from trauma does affect survival
As innovative methods for early control of intra-abdominal for delays up to 90 minutes. J Trauma. 2002;52(3):420–425.
and pelvic bleeding are introduced, it is imperative to under- 11. Schwartz DA, Medina M, Cotton BA, et al. Are we delivering
stand their application, risks, and benefits. Our single center two standards of care for pelvic trauma? Availability of an-
retrospective study suggests that there is a significant popula- gioembolization after hours and on weekends increases time
tion of injured patients that could potentially benefit from early to therapeutic intervention. J Trauma Acute Care Surg. 2014;
NCTH control devices, that a substantial majority of bleeding 76(1):134–139.
sites are above the aortic bifurcation, and that further research 12. Stannard A, Eliason JL, Rasmussen TE. Resuscitative endo-
into the safety and efficacy of these devices is warranted. vascular balloon occlusion of the aorta (REBOA) as an adjunct
for hemorrhagic shock. J Trauma. 2011;71(6):1869–1872.
13. Brenner ML, Moore LJ, DuBose JJ. A clinical series of resus-
Previous Presentation citative endovascular balloon occlusion of the aorta for hem-
This manuscript was presented at the Academic Surgical Con- orrhage control and resuscitation. J Trauma Acute Care Surg.
gress at Jacksonville, FL, on 4 February 2016. 2013;75(3):506–511.
14. Moore LJ, Brenner M, Kozar RA, et al. Implementation of
Disclosures resuscitative endovascular balloon occlusion of the aorta as
PMC, MJH, and MDS have nothing to disclose. JBH is on an alternative to resuscitative thoracotomy for noncompress-
medical advisory board for Arsenal Medical and the Tactical ible truncal hemorrhage. J Trauma Acute Care Surg. 2015;79
Combat Causality Care (TCCC) committee, is the chief medi- (4):523–530.
cal officer of Prytime Medical, and is a coinventor of the Junc- 15. Sadek S, Lockey DJ, Lendrum RA, et al. Resuscitative en-
tional Emergency Treatment Tool (licensed to North American dovascular balloon occlusion of the aorta (REBOA) in the
pre-hospital setting: an additional resuscitation option for un-
Rescue). JBH became the CMO of Prytime Medical, a com- controlled catastrophic haemorrhage. Resuscitation. 2016;107:
pany that produces a proprietary REBOA catheter, after data 135–138.
collection and analysis were completed for this study. 16. Manley JD, Mitchell BJ, DuBose JJ, et al. A modern case
series of resuscitative endovascular balloon occlusion of the
Author Contributions aorta (REBOA) in an out-of-hospital, combat casualty care
PMC was the primary author. MJH was responsible for data setting. J Spec Oper Med. 2017;17(1):1–8.
collection, analysis, and writing. MDS helped with statistical 17. Lyon M, Shiver SA, Greenfield EM, et al. Use of a novel ab-
data analysis and writing. JBH was the primary investigator dominal aortic tourniquet to reduce or eliminate flow in the
who conceived the idea of the work and was responsible for common femoral artery in human subjects. J Trauma Acute
Care Surg. 2012;73(suppl 1):S103–S105.
determination of whether an intervention could be potentially 18. Duggan M, Rago A, Sharma U, et al. Self-expanding polyure-
beneficial after reading operative notes. thane polymer improves survival in a model of noncompress-
ible massive abdominal hemorrhage. J Trauma Acute Care
References Surg. 2013;74(6):1462–1467.
1. Centers for Disease Control and Prevention. Web-based In- 19. Barnard EB, Morrison JJ, Madureira RM, et al. Resuscitative
jury Statistics Query and Reporting System. Atlanta, GA: US endovascular balloon occlusion of the aorta (REBOA): a pop-
Department of Health and Human Services, CDC, National ulation based gap analysis of trauma patients in England and
Center for Injury Prevention and Control, 2003. Wales. Emerg Med J. 2015;32(12):926–932.

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