A Case Report of Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for non-traumatic gastrointestinal hemorrhage

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a tool used in the management of hemorrhagic shock in trauma patients. REBOA has also been proposed as an option for non-traumatic hemorrhage, such as gastrointestinal (GI) hemorrhage. In this case report, the use of a partial REBOA (p-REBOA) for a patient with an acute upper GI hemorrhage is presented as a management strategy to temporize bleeding. Methods: Case information was obtained from the electronic medical record at the University Medical Center in New Orleans. Results: A 46- year-old woman presented to the Emergency Department with concern for an upper GI bleed. The patient was tachycardic on presentation and then quickly became unresponsive. Massive transfusion protocol was initiated and a p-REBOA catheter was placed in Zone 1. After the REBOA was inflated 20 mL in 2 mL increments, the patient’s blood pressure improved, while maintaining distal perfusion. An exploratory laparotomy, with an angiogram once the patient had been stabilized, was planned. Despite resuscitative efforts for more than 2 hours, the patient progressed to cardiac arrest and did not have return of spontaneous circulation. Conclusions: This case report describes the use of p-REBOA in Zone 1 to control hemorrhage in a patient with a suspected upper GI bleed. This strategy could be utilized in patients with suspected non-traumatic hemorrhage in order to control bleeding temporarily and allow for ongoing resuscitation and stabilization of a patient prior to definitive treatment.