We are now entering the “golden age” of REBOA. A number of small, single-institution studies are beginning to appear, most of which tout reasonably positive results. And enough articles are now available to even support a few authors seeking to publish review articles.
Yes, REBOA shows a great deal of promise. But there are a lot of details yet to be worked out. Here are some of the items on the REBOA “questions to answer” list:
- What are the best indications (and contraindications) when considering this highly invasive technique? You will notice that I only listed general indications here. There is some agreement at the major REBOA centers in the US, but there are a lot of differences of opinion as well.
- What kind of training is required to assure competence with this technique?
- What kind of experience, supervision, performance standards should be required for credentialing?
- What about the anatomic, physiologic, and metabolic complications of this technique?
- How long can the catheter be left in place?
- What kind of monitoring is required to assure limb and overall patient safety?
- What about the inevitable technical improvements that are ongoing? In only a few years we have moved from 12 Fr catheters to 7 Fr. From guidewire systems to wireless ones. Expect numerous advancements that will reduce complications and improve survival.
Bottom line: This is a very exciting new technique. But we are still very early in the REBOA life cycle. Everybody wants to be doing the next great thing, but be careful! We are still working with a huge knowledge deficit, and additional published work is essential. If you are working outside of an established REBOA center, I highly recommend you do two things. First, get some training for this complicated technique (see page 1). And don’t let your experience go to waste. Design or join a good study that will contribute to the global knowledge base on REBOA.
Tomorrow: References (if you want to look this stuff up)
Direct links to the REBOA series: