Feasibility and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Non-Compressible Torso Hemorrhage in a Resource-Limited Setting

Abstract

Objective: We evaluated feasibility and outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for non-compressible torso hemorrhage in a resource-limited setting.

Methods: This retrospective-prospective cohort study included 23 trauma patients undergoing REBOA at a tertiary center in Thailand (2012–2024). Primary endpoints were 24-hour and 28-day survival.

Results: Patients presented with profound shock (median systolic blood pressure 60 mmHg) and severe neurological impairment (median Glasgow Coma Scale 7); 43.5% received prehospital cardiopulmonary resuscitation. REBOA increased systolic blood pressure by 39.8±20.7 mmHg, achieving 82.6% return of spontaneous circulation. The 24-hour and 28-day survival rates were 26.1% and 21.7%, respectively—superior to historical resuscitative thoracotomy outcomes (2–8.5%). Multivariate analysis identified Glasgow Coma Scale 9–12 as the strongest survival predictor versus 3–8 (odds ratio 23.33, 95% confidence interval 1.95–279.43, P = 0.013). No limb ischemia occurred; acute kidney injury developed in 21.7%.

Conclusions: REBOA achieved favorable survival in critically ill patients without hybrid operating rooms or 24/7 interventional radiology. Glasgow Coma Scale score emerged as the key prognostic indicator, suggesting optimal efficacy when deployed before complete cardiovascular collapse. REBOA represents a feasible option in resource-limited trauma centers.