Cite this post as:
Scott Weingart, MD FCCM. EMCrit Podcast 121 – REBOA. EMCrit Blog. Published on April 6, 2014. Accessed on June 6th 2023. Available at [https://emcrit.org/emcrit/reboa/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: April 6, 2014
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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It looks really exciting and I hope I get to use one one day but isn’t it just an intravascular MAST suit? I can’t remember why the MAST suit died; there was one hanging in the resus storeroom when I was an intern but it had a lot of dust on it already and it only got dusted off to be sent to a museum. I’m really interested to hear your thoughts on what will make REBOA more useful and enduring than the MAST suit. Obviously it is a lot more elegant and it allows access to the patient. Is… Read more »
not quite understanding–nothing like a MAST suit which was created on the flawed concept of autotransfusion. Better to think of it as a intravascular aortic crossclamp.
Fair enough. Like I say, the MAST suit was just before my time. I had thought it squeezed until no blood got into the lower body but evidently it was just a venous squeeze?
Still, the critical care adventure that follows on deflation of one of these balloons after an hour or so of inflation and distal ischaemia must be something. It will be fascinating to watch this technology develop.
MAST – Squeeze the blood out of the venous side to have it pour out the hole in the arterial side + make it difficult for you to breathe.
Thanks DocXology, now that’s an image that makes sense of it for me nicely.
The Abdominal Aortic and Junctional Tourniquet (AAJT) http://www.speeroptech.com/hemorrhage-control/ is another device that has a role in these patients. It was developed as a means to externally cross clamp the aorta at the level of the aortic bifurcation. This device is designed for military field use for penetrating pelvic trauma. This can be placed quickly in the unstable patient and provide initial hemostasis and provide a bridge for placement of the REBOA or definitive surgery.
Richard Schwartz MD
Chairman and Professor
Emergency Medicine
Georgia Regents University
Is there any role for US confirmation of adequate placement and inflation of balloon vs. XR? Have they tried visualizing balloon in aorta at STC?
Place catheter, inflate balloon then when ready & US confirms position of US, use shaken air/saline flush to check position like in echo US – real bush hospital check when no radio-opaque solution available – by the way UK London HEMS is trying this technique – check BBC website Regards
yep! though landmarks should be fine for balloon. it is wire confirmation that seems to be an issue.
My Trauma group is interested in learning this (I’m hoping to get lucky and tag along). It looks like there is a training course: http://vascular-trauma.com/workinggroup.html
Anyone have any more details? Or know of other training courses?
Hey Scott…great article thanks! (Will reference it in my upcoming trauma update to the registrars).
The video they showed at SMACC demonstrating its use real time was superb…and I understand they are now developing a fluoroscopy-free system??
Great catching up on the Gold Coast…cheers!
I found this interesting little tidbit online while researching REBOA for an upcoming trauma conference. Do we have an ETA for approval or any more information on this?
http://www.pryormedical.com/wp-content/uploads/2013/06/ER-REBOA-Highlight-Sheet.pdf
about 6 months (we hope); Megan Brenner is one of the drivers of this new technology and her thoughts are this will make the device ED and intensivist friendly.
Hey Scott, Great interview once again. Thanks also to Dr. Brenner (forgive me if that is not the correct spelling). I’ve mostly heard REBOA being suggested in patients in hemorrhagic shock after sustaining pelvic fractures and or positive FAST exams as a temporizing measure for either I.R. or O.R. I understand this and am looking forward to further use and further study. However Dr. Brenner alluded to its use in patients who “come in in full arrest”. Can you further explain which Traumatic arrest patient would have REBOA implemented at shock Trauma? Would they ONLY perform REBOA on penetrating abdominal… Read more »
the role I see as ideal is the pulseless pt, with negative chest tube output who still has a beating heart on ultrasound. In these patients, they need volume and a crossclamp rather than what a thoracotomy may offer.
Dr Thomas Coombs
Rural Generalist Anaesthetist – North Queesnland Australia
Hi Scott, this technique would be comforting to have in my quiver for torrentially bleeding post partum haemorrhage patients – is dr brenner considering extending her short course to aliens? I couldnt seen her contact details anywhere. Once comfortable with the technique then its use in arrest situation.
they are in the process of creating courses for the public–will put the info on the blog as soon as they are ready.
What are your thoughts on pre-hospital REBOA? is this something that we can expect to see/practical for medics to perform? How about the REBOA compared to AAJT (prehospital).
Thank you!
Closure can be performed with a proglide device to save cut down
thank you , Scott. excellent as always