REBOA Deployment Details: Zones, Occlusion Times, and Techniques

Rationale

The Dewey 2025 AORTA registry study directly supports the existing recommendation for partial REBOA over complete occlusion by demonstrating a mortality benefit for partial Zone I REBOA compared to complete Zone I REBOA and emergency department thoracotomy. This is a reinforcement of existing content rather than a substantive addition or modification, so a citation-only change is appropriate. The citation is appended to the sentence recommending partial REBOA to reduce ischemic burden, alongside the existing Sadeghi M, et al citation.

Evidence

Content Changes

<!-- type: treatment -->

Current guidelines emphasize that Zone II (celiac to lowest renal artery) should be avoided for balloon inflation [@bulger2019]. Zone I occlusion should be limited to the shortest possible duration, often suggested to be 30 minutes or less [@bulger2019], while Zone III occlusion is preferably limited to 60 minutes or less. Intermittent or partial resuscitative endovascular balloon occlusion of the aorta (REBOA) should be considered to reduce ischemic burden [@sadeghi2018-partial].[@sadeghi2018-partial; @dewey2025].