This blog is part of the series entitled Surgical Successes. This series will highlight various surgical procedures that are currently being performed at Eskenazi Health. Recently, Dr. Katie Staton-Maxey, a trauma surgeon with Eskenazi Health and  an assistant professor of surgery with the Indiana University School of Medicine, sat down to discuss the REBOA surgical technique performed at Eskenazi Health.

When there is a major hemorrhage, or severe bleed, due to trauma or other causes, immediate action is needed to stop the bleed. One such method that is in use within the Smith Level I Shock Trauma Center at Eskenazi Health is the resuscitative endovascular balloon occlusion of the aorta, otherwise known as REBOA. This technique temporarily restricts the blood supply to blood vessels below the aorta artery, allowing surgeons to identify, control and repair complex vascular and organ injuries.

According to Dr. Stanton-Maxey, REBOA was first created by combat surgeons in the U.S. military during the 1950s as a way to quickly stop a wounded soldier from bleeding out from a traumatic wound. Seeing this success on the battlefield led to several laboratories testing it throughout the late 1980s. As catheters and catheter insertion techniques advanced, resurgence in REBOA interest occurred as a possible safe solution to hemorrhaging. 

In the past few years this technique has been used by trauma surgeons as an alternative to controlling aortic bleeding via direct clamping, which involves cutting open the chest or abdomen. While more commonly used in an emergency department or trauma department, Dr. Stanton-Maxey notes how this surgical technique has been used for abdominal aneurysm repair and some cancer operations. 

The first step of this lifesaving procedure is to access the femoral artery via the patient’s leg by using a needle with a hollow tip. Once the needle is placed, a long wire is fed through the needle and inserted into the artery. The needle is then removed and the REBOA catheter, containing a small uninflated balloon, is fed over the wire and into the artery. A blood pressure sensor is placed on the catheter to monitor the patient’s heartbeat and to signal to the surgeon when the artery is blocked by the filled balloon. Once in place, the balloon is filled with saline. When the blood pressure sensor notes a significant drop in blood pressure, that means the artery is blocked and the balloon’s inflation is complete. The balloon remains inflated while the surgeon works to control the bleeding area surgically or through other techniques.

According to Dr. Stanton-Maxey, the biggest benefit of the REBOA technique is that it allows for rapid, temporary control of a life-threatening hemorrhage, or extreme bleed. While not often used, it can help increase the time a surgeon has to identify and control severe or complex injuries that would otherwise lead to irreversible shock or death.

Determining when to use this technique is based on several different factors. These can include the patient’s health, age and severity of the injuries at hand. 

As the first Level I trauma center in the state of Indiana, the Smith Level I Shock Trauma Center has been at the forefront of trauma care and constantly works to provide the best care possible to all trauma patients. With five dedicated shock trauma rooms, the trauma team is able to evaluate and care for almost any traumatic injuries that come through its doors. For more information, please visit www.eskenazihealth.edu/health-services/emergency.