Update Course Rewind: REBOA use in Pediatric Trauma 2024

This topic falls into two categories, both black diamond and blue square, both unproven and newer practices.

According to audience poll, 50% would do laparotomy as the next step for a hypotensive 16-year-old with abdominal gunshot injury.

23% of audience chose REBOA for the case.

REBOA can be used in children.

REBOA is not super effective.

We don't do a lot of REBOA in a pediatric hospital and to do it very quickly in a patient population that you don't do it in very often is very difficult.

Most of the pediatric surgeons prefer to do laparotomy for this case.

REBOA is a procedure to control bleeding in shock or traumatic cardiac arrest where a catheter with a balloon is inserted through the femoral artery into the aorta, then the balloon is inflated to stop blood flow.

REBOA is often compared to resuscitative thoracotomy since both techniques occlude the aorta.

Thoracotomy opens the chest surgically in the ER to gain rapid access to the heart, control the source of bleeding, and control the aorta.

In the adult version of damage control therapy for hypotension and shock, REBOA is under hemorrhage control as an option in the recommendations, but it depends on what is available at your specific surgery center.

The priority is that you recognize shock in this child and treat it as quickly as you can in the most controlled environment.

When compared to thoracotomy, REBOA can take a few extra minutes to occlude the aorta and those few minutes can be crucial in a crashing patient.

REBOA would take longer than opening the abdomen or the chest if you're just needed to cross clamp the aorta.

REBOA shows some sort of survival advantage in adults, but those patients were not as sick if you look at the main trial.

There isn't a clear survival advantage for using REBOA even on the adult side, so certainly not over to the kid side.

While REBOA can be used in kids, it is rarely performed in pediatric hospitals, making rapid application challenging.

There was no clear survival advantage for using REBOA in adults.

Most surgeons favor laparotomy as the preferred option for quickly treating shock in a controlled environment.