What is a REBOA Non-Responder Trying To Tell Us

Abstract

Background:  With the growing use of REBOA as an alternative to E.D. thoracotomy in select patients, the algorithms are still evolving, and current guidelines for REBOA use appear to have gaps as evidenced by this case.  Most algorithms include chest x-ray, FAST, and pelvic x-ray to guide where to place the device, either zone 1 or zone 3.  There is a lack of guidance for patients in whom all three of these studies are negative, which we define as a non-diagnostic triad (NDT).  Furthermore, there is a lack of guidance after placement of the device in patients who fail to respond or only minimally respond.  Methods:  We describe a difficult case where a blunt trauma patient with unstable hemodynamics had marginal response to placement of zone 1 REBOA, while physical exam and imaging in the trauma bay did not reveal a source for his hypotension.  Results:  The patient was sent to the CT scanner whereupon multiple injuries were identified and detailed in the case.  The patient unfortunately expired soon after.  Conclusions:  Further clinical studies with better classification are needed in order to better understand the significance of REBOA responders and non-responders in patients with an unknown source of hypotension.  The non-diagnostic triad of negative chest x-ray, FAST, and pelvic x-ray, defined as non-diagnostic triad (NDT) represent a significantly challenging patient population that should be studied further.