A REBOA catheter is a thin, flexible tube with a small inflatable balloon at its tip. REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta, indicating its function in temporarily blocking blood flow within the body’s largest artery, the aorta. This device represents a minimally invasive approach to manage severe internal bleeding. It serves as a tool for emergency situations, aiming to stabilize patients experiencing significant blood loss.
The Purpose of a REBOA Catheter
The purpose of a REBOA catheter is to address non-compressible torso hemorrhage (NCTH). This describes severe internal bleeding within the chest, abdomen, or pelvis that cannot be controlled by applying external pressure. This type of bleeding is a leading cause of potentially preventable death in cases of major trauma. Unlike external wounds that can be compressed, internal bleeding in these areas often continues unchecked, leading to rapid blood loss and shock.
The REBOA device acts as an internal tourniquet, temporarily stopping or significantly reducing blood flow to the bleeding area. This intervention helps to maintain blood pressure and blood flow to vital organs such as the heart and brain. By temporarily controlling bleeding, REBOA provides a bridge, allowing medical teams time to prepare for and perform definitive surgical repair or other procedures to stop the hemorrhage permanently. This intervention is particularly relevant when patients are in hemorrhagic shock and not responding to standard resuscitation efforts.
How the REBOA Procedure Works
The REBOA procedure typically begins with gaining access to the common femoral artery, usually in the groin region, often guided by ultrasound. A small incision allows for the insertion of a vascular sheath, which is a hollow tube that provides a pathway into the artery. Through this sheath, the REBOA catheter, equipped with its deflated balloon, is carefully guided upwards into the aorta.
Medical imaging, such as X-rays or fluoroscopy, is used to confirm the catheter’s precise placement within the aorta. Once the catheter is positioned correctly, the balloon at its tip is slowly inflated. The inflation of this balloon occludes the aorta, blocking blood flow beyond that point. This temporary blockage helps to reduce bleeding in the injured area downstream while redirecting blood flow to the heart and brain, improving central blood pressure.
The balloon inflation is a temporary measure, designed to stabilize the patient until they can receive definitive surgical or interventional treatment. The duration of balloon inflation is kept to a minimum, ideally less than 15-30 minutes for Zone 1 and 30-60 minutes for Zone 3, to limit the risk of complications from reduced blood flow to tissues and organs below the occlusion. Once surgical control of the bleeding is achieved, the balloon is carefully deflated and the catheter is removed.
Catheter Placement Zones
The REBOA catheter’s positioning is highly specific, depending on the location of the internal bleeding. The aorta is divided into distinct zones to guide this placement. The two primary zones for REBOA deployment are Zone 1 and Zone 3.
Zone 1
Zone 1 placement involves inflating the balloon in the descending thoracic aorta, which is the section of the aorta in the chest, above the major abdominal organs. This positioning is chosen when the source of bleeding is in the abdomen, pelvis, or lower extremities. Occluding blood flow here effectively stops bleeding from major vessels supplying these areas, providing widespread hemorrhage control below the diaphragm. The catheter is advanced to 46 cm from the insertion site for Zone 1 placement.
Zone 3
Zone 3 placement involves inflating the balloon in the infrarenal abdominal aorta, located in the abdomen below the kidneys but above where the aorta splits into the leg arteries. This lower placement is used for severe bleeding in the pelvis or from injuries affecting the upper parts of the legs. By occluding the aorta in Zone 3, blood flow to the pelvis and lower extremities is reduced, while preserving blood supply to the abdominal organs. For Zone 3, the catheter is advanced to 27-28 cm from the insertion site.
Medical Scenarios Requiring REBOA
REBOA catheters are utilized in specific, life-threatening medical situations where rapid control of severe internal bleeding is necessary to prevent circulatory collapse. These scenarios often involve major traumatic injuries that result in non-compressible hemorrhage below the diaphragm. This can include patients who have sustained severe blunt trauma, such as from high-impact car accidents or significant falls, leading to internal injuries in the abdomen or pelvis.
The device is also employed in cases of penetrating trauma, such as blast injuries or gunshot wounds, particularly when these affect the abdominal or pelvic regions and cause substantial internal bleeding. Beyond traumatic injuries, REBOA has expanded its application to non-traumatic medical emergencies. A notable example is severe postpartum hemorrhage, which is uncontrolled bleeding after childbirth. It can also be considered in some cases of massive gastrointestinal bleeding or during complex pelvic surgeries to manage expected significant blood loss.