Originally developed as a less invasive alternative to emergency thoracotomy with aortic cross clamping, REBOA is performed to gain rapid control of non-compressible truncal or junctional hemorrhage.

Although there is no single indication criteria for the procedure, it is typically performed for patients with either blunt or penetrating traumatic injuries to the torso with severe hemorrhage refractory to blood product resuscitation.

[1][2] Zone 1 positioning in the descending thoracic aorta minimizes blood flow below the diaphragm and significantly reduces bleeding within the abdomen, pelvis, and lower extremities.

[2] Alternatively, Zone 3 placement within the infrarenal descending abdominal aorta reduces bleeding within the pelvis and lower extremities while preserving blood supply within the abdomen.

[2] Although REBOA does not replace the need for definitive surgical management, it may act as a temporizing measure by temporarily augmenting cardiac index to preserve cerebral and myocardial perfusion.

Early studies reported conflicting data regarding mortality and failed to establish any clear benefit of REBOA when compared to emergency thoracotomy with aortic cross clamping.

[1] Additionally, some centers have promoted REBOA deployment in patients with hypotension at risk for progression to severe hemorrhagic shock but who do not yet meet criteria for emergency thoracotomy with aortic cross clamping.

[1][2][3] Although there is no definitive consensus within the academic or surgical communities, many centers recommend balloon occlusion times of less than 30 minutes whenever possible to minimize the risk of clinically significant ischemia.