First use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in traumatic hemorrhage in Ecuador: A technical case report

Non-compressible torso hemorrhage is one of the main causes of preventable death in severe trauma, especially in hospitals with limited resources. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an adjunctive tool within damage control resuscitation, allowing temporary redistribution of blood flow to vital organs and decreasing bleeding distal to the occlusion, generating a surgical window for definitive control. We present the first documented case in Ecuador of the use of REBOA in trauma. A 22-year-old female patient who presented in profound hemorrhagic shock 8 h after a traffic accident, with grade IV hepatic trauma, grade V right renal trauma, and inferior vena cava injury. During exploratory laparotomy, a REBOA was placed in zone I through an open approach to the right common femoral artery, achieving transient hemodynamic improvement that allowed completion of damage control surgery maneuvers, including hepatic packing, nephrectomy, and vascular repair. The occlusion was maintained for 40 min. Despite intensive resuscitation and a second surgery, the patient died 58 h later from multiorgan failure. This case demonstrates the technical feasibility of implementing REBOA in second-level hospitals when specialized training exists, and highlights the need to strengthen trauma systems, optimize transfer routes, and promote structured training programs.