Intraoperative Application of Resuscitative endovascular balloon occlusion of the aorta (REBOA) to Traumatic Vascular Injury

A 63-year-old woman was in a car accident; she had been sitting in the passenger seat. In the emergency room, the patient’s blood pressure was 82/46 mm Hg, the pulse rate was 84 beats/min, and her level of consciousness was normal. The lower abdomen was bruised with a seat belt sign (Fig. 1.). The extended focused assessment sonography in trauma showed a moderate to severe intra-abdominal fluid collection in Morison's pouch and in perivesical sites. The hemoglobin level was 8.8 g/dL, and the lactate level was 1.82 mmol/L. No further imaging tests were performed, and exploratory surgery proceeded immediately. The operative findings were perforations of the transverse colon and transverse mesocolon. Repair with primary sutures was performed. After surgery, the patient went to the intensive care unit; immediately after her arrival there, intra-abdominal bleeding was confirmed through the drainage bag. Therefore, she underwent a second emergency laparotomy. Vessels near the superior mesenteric artery under the transverse mesocolon were damaged. We could not find the definite bleeding focus because massive bleeding obscured vision, and the patient’s blood pressure was unstable. We thus performed resuscitative endovascular balloon occlusion of the aorta (REBOA) intraoperatively. The balloon was placed in zone I of the aorta, but for various reasons, we could not pinpoint the location of the catheter in operating room (Fig. 2.). After bleeder ligation and deflation of the balloon, there was no more active bleeding. The balloon was maintained for 21 minutes Treatment Progression in Trauma eISSN: 2508-8033 pISSN: 2508-5298