Expanding the role of REBOA: From last-resort measure to enabler of surgery and angioembolization in shock

Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used for non-compressible torso hemorrhage, but its role in blunt abdominal trauma (BAT) with unstable hemodynamics remains debated, especially in high-level trauma centers with rapid hemostasis access. Methods: We retrospectively studied BAT patients with unstable hemodynamics (2017–2022). Patients receiving REBOA were compared with those managed without it. Primary outcomes were the proportion undergoing definitive hemostasis (surgery or angioembolization) and time from emergency department (ED) arrival to hemostasis. Secondary outcomes included blood pressure response, 24-h survival, and in-hospital mortality. Propensity score matching (PSM) reduced confounding. Results: Of 159 patients, 13 received REBOA. Intra-abdominal hemorrhage was present in 95 and retroperitoneal in 64. REBOA significantly increased systolic blood pressure (55 → 106 mmHg; 46.8 → 111.6 mmHg; both p = 0.001). Intra-abdominal hemorrhage cases with REBOA more often proceeded to angioembolization (60 % vs 37.8 %), and 75 % of retroperitoneal REBOA cases underwent angioembolization under improved physiology. After PSM, REBOA did not delay hemostasis (96.3 vs 109.9 min; p = 0.931). Survival was similar between groups. Conclusions: REBOA stabilizes critically unstable BAT patients, permitting timely surgery or angioembolization and offering a chance for definitive hemorrhage control.