Resuscitative endovascular balloon occlusion of the aorta

Resuscitative endovascular balloon occlusion of the aorta (REBOA) reduces sub-diaphragmatic haemorrhage while increasing proximal perfusion in non-compressible truncal exsanguination.1 A catheter-borne balloon is inflated in the descending aorta, initially to complete occlusion then partially deflated, the aim being to optimise coronary and cerebral perfusion, while minimising distal haemorrhage and ischaemia. Resuscitative endovascular balloon occlusion of the aorta can be considered in blunt or penetrating sub -diaphragmatic injury with life-threatening bleeding or trau-matic cardiac arrest in centres with an established, proto-colised system for its deployment.2,3There is currently a lack of high-grade evidence demon-strating superiority over conventional manual aortic occlu-sion (AO) via thoracotomy;2 the ongoing UK-REBOA trial is the first RCT to assess its efficacy. Nonetheless, REBOA is used at an increasing number of international centres. Although mostly deployed in major trauma, it has also been used in sub - diaphragmatic haemorrhage of other aetiologies and in non -traumatic cardiac arrest.4,5