REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta | FrontLine Medical
What is REBOA?
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a life-saving technique used to temporarily control hemorrhage in critically bleeding patients. It involves inserting a balloon catheter into the aorta via the femoral artery to reduce blood flow below the balloon, maintaining perfusion to vital organs and buying time for definitive care.
REBOA is a valuable tool in both civilian and military medicine and is used by trauma surgeons, emergency physicians, interventional radiologists, vascular surgeons, and field medics.
Why It Matters: In cases of non-compressible hemorrhage, speed and simplicity can mean the difference between life and death. REBOA offers a minimally invasive solution when seconds count.
How REBOA Works
Step-by-Step Overview:
- Vascular Access: A sheath is placed in the common femoral artery.
- Catheter Insertion: A REBOA catheter is advanced through the sheath into the aorta.
- Balloon Placement: The balloon is inflated in either Zone I (descending thoracic aorta) or Zone III (infrarenal aorta), depending on the injury location.
- Temporary Hemorrhage Control: The inflated balloon slows or stops distal blood flow.
- Balloon Deflation and Removal: Once definitive surgical control is achieved, the balloon is deflated and withdrawn.
Meet the COBRA-OS®
FrontLine’s COBRA-OS® is the first 4 Fr, wire-free REBOA catheter, uniquely engineered for rapid, controlled hemorrhage management in trauma, OB, and field environments.
Key Features:
- No guidewire required
- Ultra-low profile (4 Fr) reduces access complications
- Ideal for both hospital and pre-hospital use
The COBRA-OS® is a next-generation REBOA solution designed for fast deployment and life-saving control, wherever care is needed.
Download the COBRA-OS® Product Brief
Request a Demo of COBRA-OS®
Clinical Applications of REBOA
REBOA is deployed in a range of critical care environments:
Trauma
- Non-compressible torso hemorrhage
- Alternative to resuscitative thoracotomy in certain cases
- Temporizing measure before definitive surgical control
Postpartum Hemorrhage
- Risk of severe OB hemorrhage (e.g., PAS cases)
- Can be used prophylactically
- Can temporize before definitive control
Military & Pre-Hospital Medicine
- Used by forward surgical teams and combat medics
- Lightweight, portable for austere conditions
- Enables hemorrhage control in resource-limited settings
More about REBOA
Frequently Asked Questions
REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta. It’s a minimally invasive technique that offers temporary hemorrhage control in critically injured or bleeding patients by occluding the aorta.
Unlike resuscitative thoracotomy, which is highly invasive and involves opening the chest to manually clamp or compress the aorta, REBOA is a percutaneous femoral arterial procedure that involves occluding the aorta with a balloon catheter.
Zone I occlusion (from the left subclavian artery to the celiac artery) is typically used for intra-abdominal hemorrhage, while Zone III occlusion (from the lowest renal artery to the aortic bifurcation) is used for pelvic or lower extremity bleeding. Correct placement is critical to effectiveness and minimizing ischemic complications.
Ideally, occlusion should not exceed 30–45 minutes in Zone I due to risk of ischemia to abdominal organs. Zone III occlusion allows for slightly longer durations, but each case must be evaluated individually based on patient stability and response.
REBOA carries risks such as vascular injury, arterial dissection, balloon migration, ischemia to distal organs, reperfusion injury, and access site complications. Proper training and adherence to protocol significantly reduce these risks.
Yes, though its use is currently limited to specific systems with well-established training and protocols. In military and select EMS settings, REBOA has been successfully deployed. Devices like COBRA-OS, which require no guidewire and have a smaller profile, make pre-hospital use more feasible.
REBOA has shown promise in managing severe postpartum hemorrhage, including cases related to Placenta Accreta Spectrum disorders. It is often considered when conventional methods are insufficient or when rapid vascular control is needed prior to surgical intervention.
COBRA-OS® is the first 4 Fr, wire-free REBOA catheter. Its low-profile design reduces access-related complications, and the absence of a guidewire simplifies and speeds up the procedure, especially in time-critical or pre-hospital settings.
REBOA should be performed by clinicians trained in vascular access and endovascular techniques. Typically, trauma surgeons, emergency physicians, radiologists, vascular surgeons, and specially trained medics in military environments perform the procedure. Institutional credentialing guidelines vary.
Clinical and registry data from organizations such as the American Association for the Surgery of Trauma (AAST), have demonstrated improved outcomes and survival in select patient populations. Continued research is shaping protocols and indications.
REBOA serves as a critical adjunct in DCR, offering temporary hemorrhage control while resuscitative efforts and surgical prep continue. It helps maintain central perfusion, providing a bridge to definitive care in severely injured patients.
Watch REBOA in Action
See how COBRA-OS® enables rapid, controlled deployment in life-threatening bleeding scenarios.
Get in Touch
Interested in learning more about REBOA or COBRA-OS®?
Let’s connect whether you’re part of a trauma system, OB unit, or military procurement team.
