FOAMcast - An Emergency Medicine Podcast · FOAMcast

REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta

·22 min·1 clip

REBOA patients had 54% 90-day mortality versus 42% with standard care in this JAMA trial.

1. FOAMcast's REBOA episode focuses on resuscitative endovascular balloon occlusion of the aorta and a new JAMA study. 2. Jeremy Faust hosts with Dr. Lauren Westifer, and both speak from emergency medicine and resuscitation practice. 3. The episode asks whether REBOA can control torso hemorrhage without delaying definitive treatment. 4. The hosts describe REBOA as a 7 French catheter placed in the common femoral artery and inflated in zone 1 or zone 3. 5. They contrast REBOA with resuscitative thoracotomy, which they describe as messy and high-mortality. 6. The discussion explains the physiologic goal of increasing afterload and preserving flow to the heart and brain. 7. They note that thoracotomy is invasive, while REBOA is a percutaneous, minimally invasive procedure. 8. The hosts emphasize the risks of distal ischemia, emboli, and prolonged ischemic time. 9. They cite a joint statement from the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians. 10. That statement says no current high-grade evidence clearly shows REBOA improves outcomes or survival over standard treatment for severe hemorrhage. 11. The JAMA study is identified as a randomized controlled trial across 16 trauma centers in the United Kingdom. 12. The trial enrolled 89 patients between 16 years and older in 2021 and 2022. 13. Most enrolled patients had blunt trauma, and almost a quarter had undergone CPR. 14. Patients were randomized to REBOA plus standard care or standard care alone. 15. The REBOA arm received one day of training after an earlier two-day format was shortened. 16. Only 46 patients were analyzed in the REBOA group and 43 in the standard-care group. 17. The main result was 54% 90-day mortality with REBOA versus 42% with standard care. 18. The hosts also note that the Bayesian trial stopped for harm and that the probability of REBOA reducing death remained low. 19. Listeners who work in trauma, emergency medicine, or prehospital resuscitation will get the most from this episode. 20. Listeners seeking light medical banter without trial methods or trauma care details may skip it.

As heard by us

A skeptical look at a high-stakes trauma tool that sounds elegant and may not help.

Foamcast takes on REBOA, the aortic balloon technique that drew real excitement in the foam era, and keeps the focus on the question that matters: whether it helps the sick patients it is meant to save.

Read the full review in PlayNext →

Why you'd press play

When you want a blunt read on whether REBOA deserves the hype.

Read the full recommendation in PlayNext →

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