Pathophysiology of Endovascular Resuscitation
Type
ReinforcementConfidence
72%
Created
Mar 27, 2026
Evidence
2 sources
Rationale
Both articles are already substantively represented in the existing section text. The UK-REBOA RCT (PMID 37824132) is cited as Jansen JO, et al and its findings are accurately described. The Marcelo 2024 REBOA complications review (PMID 38347890) is cited as Ribeiro Junior MAF, et al and its content is reflected in the cREBOA bullet point. The suggested citation keys Jansen JO et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023. PMID: 37824132. DOI: 10.1001/jama.2023.20850. and Ribeiro Junior MAF. Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review. Trauma Surg Acute Care Open. 2024. PMID: 38347890. DOI: 10.1136/tsaco-2023-001267. appear to be variant keys for the same underlying sources, likely representing different chapter-level citation instances. To avoid duplication of content while ensuring the new keys are registered (as they may be required for cross-chapter bibliography consistency), they are appended as co-citations alongside their existing counterparts at the relevant sentences. No substantive text changes are warranted because the clinical claims these articles support are already accurately stated. Citation density is kept consistent with the existing section style — one additional citation per relevant sentence — avoiding over-citation. No contradictions or new findings requiring content modification were identified.
Evidence
Content Changes
<!-- type: physiology --> Hemorrhagic shock produces progressive **oxygen debt** and a self-reinforcing cycle of hypoperfusion, acidosis, hypothermia, and coagulopathy (“lethal("lethal triad/lethal diamond”).diamond"). Early hemorrhage control and **damage control resuscitation (DCR)** are therefore time-critical. [@rotondo1993] [@spahn2019] **Where endovascular trauma management (EVTM) fits in DCR** EVTM complements DCR by providing **rapid proximal or selective hemorrhage control** (e.g., resuscitative endovascular balloon occlusion of the aorta (REBOA), selective balloon occlusion, embolization, covered stents/stent-grafts) that can shorten time-to-hemostasis and reduce the duration of profound shock while definitive surgical/interventional radiology (IR) control is arranged. [@morrison2014] [@trauma2016-endovascular] However, the clinical benefit of REBOA remains a subject of intense debate; recent evidence from the UK-REBOA randomized clinical trial (RCT) indicated that the addition of REBOA to standard care in the emergency department (ED) did not improve survival and may even increase mortality, potentially due to procedural delays or complications [@jansen2026].[@jansen2026] [@jansen2026-i]. **Physiologic principles of aortic balloon occlusion** - **Complete occlusion (cREBOA):** maximizes proximal perfusion but risks severe distal ischemia, reperfusion injury, and procedural complications such as vascular access site injury or arterial thrombosis; use the **shortest feasible occlusion time** and transition quickly to definitive control. [@bulger2019] [@marcelo2024] [@marcelo2024-g] - **Partial/intermittent REBOA (pREBOA/iREBOA):** titrated deflation can preserve some distal flow and attenuate metabolic burden compared with continuous complete occlusion, especially as a bridge when definitive hemostasis is not yet achieved. [@sadeghi2018-partial] **Endovascular hemostasis and preservation of perfusion** Covered stents and stent-grafts can **exclude arterial disruption while maintaining in-line flow**, which is particularly valuable for junctional vessels (subclavian/axillary/iliac) that are difficult to expose surgically in unstable patients. [@markov2011] Embolization provides distal/branch control (e.g., pelvic arterial bleeding, solid organ injury) and is commonly integrated into pelvic hemorrhage pathways alongside packing and/or REBOA depending on physiology and resource availability. [@coccolini2017-wses] For surgical damage control concepts (packing, abbreviated laparotomy, open abdomen strategy), see [[Damage Control Surgery]] and [[Open Abdomen]]. [@wses2018]