Implementation and Adaptation of Pathway of Resuscitative Endovascular Balloon Occlusion of the Aorta after Traumatic Injury.

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an invented method to facilitate a minimally invasive occlusion of the aorta to stop a life-threatening hemorrhage. This review described an established pathway for noncompressible exsanguination (REBOA procedures) in trauma patients at a Level 1 trauma center. A detailed description starting from the structural changes of the hospital and facilities itself, the initial thoughts, implementation of the process, and continuous revision and improvement of guidelines were discussed. A multidisciplinary core team consisting of trauma surgeons, anesthesiologists, interventional radiologists, and operating room (OR) staff developed step-by-step clinical practice guidelines for using REBOA at our trauma center. A comprehensive training program for specialized procedural training was implemented to ensure the competency of all relevant medical personnel in managing trauma patients. The REBOA guidelines underwent plan-do-check-act quality cycle improvement until the latest guidelines were reached with each use of REBOA in a trauma patient, leading to further auditing of the guidelines to identify areas for improvement. The current review discusses the critical role of adopting innovative technologies and adapting protocols in trauma care, particularly for vulnerable patients with a high risk of morbidity and mortality. Continuous process improvement, procedural refinement, and evolving guidelines are essential prerequisites for optimizing patient outcomes. We described a valuable framework for other trauma programs to implement and adapt similar endovascular bleeding control approaches, thereby potentially enhancing patient care.