Hemorrhage control has come a long way over the years, and today, European surgical teams are at the forefront of refining these life-saving techniques. Although REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) originally emerged from military medicine, it has steadily found its place in civilian healthcare settings. Recently, at Hospital OSI Araba ESI in Vitoria, Spain, doctors reached an important milestone when they successfully used the COBRA-OS® (Control of Bleeding, Resuscitation, Arterial Occlusion System) – a novel low-profile REBOA device designed for rapid deployment and precise control – in a high-risk obstetric case.
Expanding Beyond Trauma Applications
When REBOA first hit the scene, it was mainly used for trauma – the kinds of cases that keep trauma surgeons up at night. But the Vitoria team showed us something different. They took on a case of placenta accreta – one of those obstetric complications that makes every surgeon in the room hold their breath. When the placenta grows too deeply into the uterine wall, bleeding can become critical within moments. Getting this case right doesn’t help just one patient; it helps both baby and mother survive a potentially catastrophic situation. Rather than using endovascular aortic occlusion as a last resort, the Vitoria team made it part of their planned approach to a high-risk cesarean. That’s what makes this case so significant. They showed us that proper planning can prevent potentially catastrophic bleeding—the kind that used to send obstetric teams scrambling. For those in the trenches of high-risk obstetrics, having another tool like this up their sleeves could make all the difference.
Technical Aspects
The surgical team chose the lowest profile REBOA device on the market, the COBRA-OS® at 4 French. Low profile devices are critical when being deployed in smaller female vascular anatomy and in the hypercoagulable state of pregnancy. Dr. Maynar’s occlusion protocol broke new ground in European practice. They inflated the balloon for seven minutes at a time, giving two minutes between each inflation for blood flow to resume, and repeated this pattern six times. When they saw the bleeding was under control, they stretched the gap to twenty minutes.
Multidisciplinary Coordination
Success hinged on precise coordination between specialties. The anesthesia team initiated management with epidural placement before arterial access. While the interventional radiology team handled the delicate task of threading the catheter through the femoral artery, the obstetric team focused on delivering the baby safely by cesarean. It’s this kind of seamless teamwork – each specialist knowing their role and timing – that makes complex procedures look almost routine.
Dr. López Zárraga’s leadership as Head of the Vascular and Interventional Radiology Section at Hospital OSI Araba ESI guided the successful implementation of their REBOA program. The coordination between interventional radiology, gynecology, and anesthesia enabled the successful completion of this first European COBRA-OS® case for postpartum hemorrhage control.
Outcome
The immediate results were clearly positive: successful delivery of a 3-kg male infant and discharge of both mother and child within 72 hours without complications. This outcome demonstrates the potential for REBOA in carefully selected obstetric cases when performed by an experienced team. Just as importantly, the rapid recovery time—comparable to an uncomplicated cesarean section—suggests that REBOA, when properly executed, doesn’t necessarily extend hospital stays or add to the patient’s recovery burden. This result could help support its expanded use in high-risk obstetric cases where severe hemorrhage is a known risk.
Future Implications
Beyond the excellent outcome, what matters most about this case is how it pushes the boundaries of what’s possible. REBOA should no longer be viewed mainly as a last-resort tool for trauma. If there are good options now available to treat high-risk obstetrical patients, we need to focus on how to best prepare teams to handle these stressful procedures and get these tools in the right hands. High-quality training and gathering experience will shape how high-risk obstetrical centers use endovascular aortic occlusion in the coming years.
References:
- https://innovasc.es/en/first-reboa-cobra-os-case-in-europe-at-hospital-osi-araba-esi/
