Prolonged Partial REBOA: A Practice Paradigm for Managing Hemorrhage from Abdominal Gunshot Wounds

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a valuable tool for management of life-threatening truncal hemorrhage. However, prolonged use of REBOA is limited by the ischemia that it causes distal to the occlusion. Partial REBOA (pREBOA) is a developing technique to inflate the balloon partially to allow for a variable degree of distal blood flow and mitigate some of the complications of prolonged occlusion of the aorta while also ameliorating ongoing blood loss. We describe a case of a patient who presented with a gunshot wound to the right upper quadrant of the abdomen with significant liver, kidney, and colon injuries. The patient was successfully treated with pREBOA for 20 hours without ischemic sequalae. This is the longest reported use of prolonged
pREBOA and suggests that this technique may offer a means for hemorrhage control in the pre-/intra- and postoperative settings.