Resuscitative endovascular balloon occlusion of the aorta in trauma patients: Past, present, and future

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a critical intervention for managing severe hemorrhagic shock in trauma patients. By temporarily occluding the aorta, REBOA aims to stabilize hemodynamics and prevent cardiovascular collapse until definitive hemorrhage control can be achieved. However, the clinical efficacy and optimal use of REBOA remain subjects of ongoing debate. This narrative review synthesizes the latest evidence on clinical outcomes, complications, and patient selection to provide a comprehensive assessment of REBOA's role in trauma resuscitation. This review is based on a selective analysis of the current literature, including clinical studies, randomized controlled trials, and meta-analyses, to evaluate the benefits and risks associated with REBOA in trauma settings. While REBOA technology has advanced significantly and its use has expanded across trauma centers, evidence-based guidelines for its application remain limited. The optimal indications and target populations for REBOA have yet to be clearly defined. Recent studies, including the only randomized controlled trial on REBOA to date, suggest that its use in hemodynamically unstable patients does not confer a mortality benefit and may even increase mortality compared to standard care alone. Furthermore, REBOA is associated with substantial risks, including ischemia-reperfusion injury, acute kidney injury, arterial injury, arterial embolism, limb ischemia, and even amputations. These complications highlight the need for careful patient selection and procedural refinement. Current evidence does not support the routine use of REBOA in trauma patients with hemorrhagic shock. Further research is essential to identify specific subpopulations that may benefit from this intervention and to optimize its application to maximize survival while minimizing complications. Until more robust data are available, REBOA should be employed judiciously, with careful consideration of its risks and benefits in individual cases.