Prehospital resuscitative endovascular balloon occlusion of the aorta during long-distance ground transport for traumatic liver injury: A case report.

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an established adjunct treatment of hemorrhagic shock caused by subdiaphragmatic bleeding. However, evidence for its use in prehospital settings and long-distance transportation in remote locations remains limited. Herein, we report a case of hemorrhagic shock secondary to traumatic liver injury, for which prehospital REBOA was successfully employed.

Case presentation: A 41-year-old man sustained multiple traumatic injuries after being run over by heavy machinery. The patient was diagnosed with hemorrhagic shock resulting from a grade IIIb liver injury. Owing to limited local resources and the anticipated clinical deterioration during long-distance transportation to an emergency medical center, a physician-staffed ground ambulance was dispatched. During which the hemodynamic status of the patient deteriorated, tracheal intubation and REBOA were performed in the ambulance. Partial aortic occlusion was initially applied, followed by complete occlusion when cardiac arrest was imminent. On arrival in the operating room, the patient underwent massive blood transfusion, damage-control laparotomy with perihepatic packing, and subsequent transcatheter arterial embolization. No REBOA-related complications occurred. The patient was discharged from the intensive care unit on hospital day seven.

Conclusion: Prehospital REBOA may serve as an effective bridge for definitive hemorrhage control during long-distance transportation in resource-limited regions. Successful implementation requires experienced trauma teams and coordinated system-level management.