Table 1

Considerations for use of REBOA at the echelons of care

Role typeDescription of roleAdvantages of useDisadvantages of use
Role 4
  • Definitive medical care

  • Located outside of theatre

  • Definite surgeon involvement

  • May avoid morbidity of a thoracotomy

  • Less risk of physician injury compared with thoracotomy

  • Could delay a necessary thoracotomy

  • Unlikely required at this level of care

Role 3
  • Specialist surgical and medical capabilities

  • Intensive care capabilities

  • Holding capabilities

  • Definite surgeon involvement

  • May avoid morbidity of a thoracotomy

  • Less risk of physician injury compared with thoracotomy

  • Military experience with REBOA in this environment

  • Could delay a necessary thoracotomy

Role 2
  • Damage control resuscitation

  • Basic imaging and laboratory capabilities

  • Short-term holding of patients

  • Likely surgeon involvement

  • May avoid morbidity of a thoracotomy

  • Less risk of physician injury compared with thoracotomy

  • Military experience with REBOA in this environment

  • Could delay a necessary thoracotomy

Role 1
  • Primary care

  • Emergency resuscitation

  • Preparation for evacuation

  • Performed by a physician

  • After initial damage control resuscitation

  • Opportunity for prophylactic placement

  • May allow more patients to survive to surgical care

  • Patients not evaluated by a surgeon

  • May delay transport

  • May be used unnecessarily

  • Danger of prolonged ischaemia if evacuation delayed

Role 0
  • Point of injury care

  • Earliest possible non-compressible haemorrhagic control

  • Opportunity for prophylactic placement

  • May allow more patients to survive to surgical care

  • Performed by non-physician

  • Before adequate resuscitation

  • May delay transport

  • May be used unnecessarily

  • Danger of prolonged ischaemia if evacuation delayed

  • Difficult to deploy and use in tactical environment

  • REBOA,┬áresuscitative endovascular balloon occlusion of the aorta.