S4E10: Intro to REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) - Bonus episode with Dr Andrew Neill

10 Mar

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.