REBOA Algorithm

Based on Shaw & Brenner, J Trauma Acute Care Surg 2025 ('What You Need to Know')

1 step

A: Hypotensive Trauma Patient — Partial or Non-Responder

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REBOA is indicated for the patient in hemorrhagic shock from noncompressible torso hemorrhage below the diaphragm who is a partial or non-responder to resuscitation (SBP < 90 mm Hg despite initial blood products). It temporizes visceral hemorrhage until definitive control and is an alternative to resuscitative thoracotomy (RT) when the sole purpose of opening the chest is aortic occlusion.

Clinical Note

REBOA offers only a short window to definitive hemorrhage control. It is NOT appropriate for patients who require transfer to another facility or when expedient operative/IR capability is unavailable. Patients with a cardiothoracic source of exsanguination are best served by RT.

References supporting this activity

Shaw J, Brenner M. Resuscitative endovascular balloon occlusion of the aorta: What you need to know. J Trauma Acute Care Surg. 2025;98(6):831–839.
Read source: Shaw J, Brenner M. Resuscitative endovascular balloon occlusion of the aorta: What you need to know. J Trauma Acute Care Surg. 2025;98(6):831–839. (opens a new tab)
Bulger EM, Perina DG, Qasim Z, et al. Clinical use of REBOA in civilian trauma systems in the USA, 2019: a joint statement from ACS-COT, ACEP, NAEMSP and NAEMT. Trauma Surg Acute Care Open. 2019;4(1):e000376.
Read source: Bulger EM, Perina DG, Qasim Z, et al. Clinical use of REBOA in civilian trauma systems in the USA, 2019: a joint statement from ACS-COT, ACEP, NAEMSP and NAEMT. Trauma Surg Acute Care Open. 2019;4(1):e000376. (opens a new tab)
Inaba K, Alam HB, Brasel KJ, et al. A Western Trauma Association critical decisions algorithm: resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2022;92(4):748–753.
Read source: Inaba K, Alam HB, Brasel KJ, et al. A Western Trauma Association critical decisions algorithm: resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2022;92(4):748–753. (opens a new tab)
Cralley AL, Vigneshwar N, Moore EE, et al. Zone 1 endovascular balloon occlusion of the aorta vs resuscitative thoracotomy for patient resuscitation after severe hemorrhagic shock. JAMA Surg. 2023;158(2):140–150.
Read source: Cralley AL, Vigneshwar N, Moore EE, et al. Zone 1 endovascular balloon occlusion of the aorta vs resuscitative thoracotomy for patient resuscitation after severe hemorrhagic shock. JAMA Surg. 2023;158(2):140–150. (opens a new tab)
Russo RM, White JM, Baer DG. Partial resuscitative endovascular balloon occlusion of the aorta: a systematic review of the preclinical and clinical literature. J Surg Res. 2021;262:101–114.
Read source: Russo RM, White JM, Baer DG. Partial resuscitative endovascular balloon occlusion of the aorta: a systematic review of the preclinical and clinical literature. J Surg Res. 2021;262:101–114. (opens a new tab)

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