Telemedicine Supervision of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Catheter Placement

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Qasim Z, Graham C 22(1). 108 - 110 (Case Reports)

The rapid control of traumatic or nontraumatic exsanguinating hemorrhage in critically injured patients is key to limiting morbidity and mortality in civilian and military practice. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to address potentially preventable death from torso or lower extremity junctional hemorrhage. This time-critical, high-acuity, low-occurrence procedure sometimes precludes the appropriate supervision of clinicians familiar with it. We describe the case of a patient who had recently undergone liver transplantation presenting to the intensive care unit (ICU) and found to be in severe nontraumatic hemorrhagic shock, necessitating REBOA placement as part of the resuscitation. The bedside proceduralist was trained but inexperienced in the procedure and was supervised by a telemedicine intensivist, resulting in rapid and safe insertion. We describe what to our knowledge is the first use of telemedicine to supervise the successful placement of a REBOA catheter in a critically ill patient and discuss how this can potentially benefit military clinicians working in low-resource, far-forward environments.

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