As 2025 comes to a close, I want to reaffirm our support for the full spectrum of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) techniques; from complete occlusion to partial occlusion, intermittent occlusion, and even the emerging “intermittent partial” approach. In my practice as a vascular surgeon, I’ve seen each of these strategies save lives. I wouldn’t fix a ruptured abdominal aortic aneurysm with a strictly partial REBOA approach. There’s a growing trend in our field to favor partial REBOA for its physiologic benefits, and indeed evidence shows partial REBOA can mitigate ischemia and extend safe occlusion times[1][2]. However, this doesn’t mean abandoning REBOA as it was initially intended. The choice of occlusion strategy should always be guided by the patient’s situation and left to the treating clinician. Our role at Front Line Medical Technologies is to ensure you have the tools and confidence to use whichever occlusion level is needed for each patient.
Complete Occlusion: Still a Vital Tool
It’s true that prolonged complete aortic occlusion can cause distal ischemia and reperfusion injury, contributing to organ damage[3]. This concern has led some experts to almost eschew full occlusion in favor of less occlusive techniques. But as a clinician, I know there are scenarios where nothing replaces complete occlusion of the aorta. In a patient with torrential hemorrhage or cardiac arrest from trauma, full occlusion offers immediate control and maximizes central perfusion to the heart and brain. The key is using this strategy appropriately; as a bridge to definitive hemorrhage control, and not for a second longer than needed. We continue to support the use of complete REBOA when indicated, even as we refine ways to minimize its downsides. After all, early-generation REBOA devices were designed for full occlusion, and countless lives have been saved by timely, decisive aortic balloon inflation in hemorrhagic shock. Our stance is balance: embrace new techniques, but keep full occlusion in the toolkit for those critical moments where “turning off the tap” is truly lifesaving.
Partial & Intermittent REBOA: Advances and Key Evidence
The past couple of years have brought robust data validating partial and intermittent REBOA strategies. In partial REBOA (pREBOA), the balloon is titrated to allow some aortic blood flow, preventing the utter stagnation of distal circulation. In intermittent REBOA (iREBOA), we periodically deflate the balloon to reperfuse distal organs before re-occluding. These techniques aim to extend the “golden hour” of occlusion by reducing ischemic burden, and the findings are encouraging. For example, a recent analysis from the PROMPT trial showed that partial REBOA nearly doubled the safe occlusion time in zone 1 (from ~30 minutes to ~45 minutes) and cut complication rates ; acute kidney injury dropped from 33% to 19% and blood transfusion needs fell by ~25% compared to complete occlusion[2]. Another study demonstrated that partial REBOA can promote more favorable outcomes than total occlusion, highlighting fewer ischemia-related issues[3].
Intermittent REBOA has likewise proven its value. By cycling the balloon inflation, clinicians can buy time in prolonged hemorrhagic shock scenarios. In a comparative experimental study, partial occlusion required fewer blood transfusions and spent far less time at full inflation (about 30% of the time) than an intermittent fully occlusive approach (which was at full inflation ~74% of the time)[4][5]. This suggests partial REBOA may stabilize patients with less drastic swings in blood pressure or perfusion. That said, each method has its place; intermittent REBOA might be preferable when one needs to completely halt bleeding but can intermittently allow flow, whereas partial REBOA provides continuous limited flow. What we’re now seeing emerge is essentially an “intermittent partial” strategy; a nuanced blend of both, where we partially occlude the aorta and periodically adjust the balloon to fine-tune perfusion. This concept is still evolving, but it underscores one theme: REBOA is not one-size-fits-all, and fine control is the future. I believe we must equip and empower clinicians to tailor occlusion to the patient’s needs in real time.
The COBRA-OS®: Putting Control in Clinicians’ Hands
One of my priorities as Chief Medical Officer has been to ensure our device, the COBRA-OS®® (Control of Bleeding, Resuscitation, Arterial Occlusion System), truly supports all occlusion strategies. I’m proud that the COBRA-OS® is a mature, proven device capable of full, partial, or intermittent occlusion based on patient needs[6]. We often say it’s “provider-controlled” by design; meaning you decide how much to inflate and when to adjust. The device’s 4 French low-profile catheter and uniquely designed safety shoulder give you the finesse to titrate occlusion pressure with confidence[6]. In practical terms, this means you can start with full occlusion to stabilize a crashing patient, then transition to partial flow as they respond; all with the same device. Or you can perform intermittent holds and releases as needed. The COBRA-OS® doesn’t lock you into one mode; it puts the full range of REBOA control in your hands. Our goal is to remove barriers and complexity, so that you can focus on the patient, not on fiddling with equipment. Over the past year, I’ve been encouraged to see more trauma centers and critical care teams adopt the COBRA-OS® for its versatility and simplicity. It’s been used not only in major trauma but also in specialized scenarios like ruptured visceral aterial aneurysms, cardiac arrest resuscitation, and obstetric hemorrhage, proving its reliability across the board[7][8]. We designed the COBRA-OS® to be straightforward but not simplistic; it’s as powerful as the clinician using it. By covering the full spectrum of occlusion, the device upholds our philosophy: give the provider control, and great outcomes will follow.
Expanding Horizons: REBOA in Postpartum Hemorrhage
An area of particular pride this year has been the expansion of REBOA into obstetric care, specifically for postpartum hemorrhage (PPH). Uncontrolled PPH, such as from placenta accreta spectrum, is a leading cause of maternal mortality, and traditional methods often fall short. Over the past couple of years, we saw groundbreaking work from teams at Texas Children’s Hospital (Baylor College of Medicine, Houston) and Atrium Health Wake Forest using the COBRA-OS® as a prophylactic aortic occlusion tool during high-risk deliveries[9][10]. The results presented at the Placenta Accreta Spectrum meeting were very encouraging. One center reported significant reductions in blood loss and transfusion requirements when using our device in a targeted hemorrhage control strategy[10]. Another center described how both intermittent and partial REBOA applications with the COBRA-OS® helped manage bleeding in real time[10]. In practical terms, this meant some mothers avoided emergency hysterectomies and survived life-threatening hemorrhages because we could “turn down the tap” of aortic flow just enough to stop the bleeding while keeping the mom’s lower body perfused. It shows that a well-executed occlusion strategy; whether complete, partial, or intermittent; can be transformative outside the trauma bay as well. The broadening of REBOA’s use-case reinforces that our comprehensive approach to occlusion is on the right track. When I teach workshops or assist in these cases, my message is clear: use the level of occlusion that achieves your clinical goal, no more, no less. The COBRA-OS® has matured into a tool that enables exactly that kind of fine-tuned care, and our recent obstetric cases are proof.
Looking Ahead; Trusting Clinicians to Choose
In reflecting on this year, one theme stands out: trust the clinicians. Whether it’s a trauma surgeon in the ER, an interventional radiologist in the IR suite, or a vascular surgeon in a hybrid OR; those of you on the front lines know best when it comes to the principle of proximal control with major bleeding. Our job at Front Line Medical is to back you up 100%. That means providing you with a device that is versatile and reliable, and sharing knowledge from the latest studies so you can make informed decisions at the bedside. I acknowledge that some in our field have grown skeptical of REBOA due to a variety of factors, not the least of which is industry bias. However, I would caution against rigid dogma. A bleeding patient too dynamic for one-size-fits-all rules. In 2025, we learned more than ever that the optimal REBOA strategy is patient-specific. Going into the new year, I remain confident that supporting the full range of occlusion techniques for the specific patient in front of you is the surest way to improve outcomes.
Here’s to another year of innovation grounded in clinical reality, and to always putting the patient first.
Sincerely,
Adam Power, MD, MPhil
Chief Medical Officer, Front Line Medical Technologies
(Dr. Power is a vascular surgeon and co-founder of Front Line Medical. The views expressed are his own, informed by both current evidence and clinical experience.)
[1] [2] A PROMPT Update on Partial REBOA: Initial Clinical Data and Overview of the DoD-Funded Partial REBOA Outcomes Multicenter ProspecTive (PROMPT) Study – PubMed
https://pubmed.ncbi.nlm.nih.gov/39160869/
[3] Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study | Scientific Reports
[4] [5] 343 Extending the Golden Hour: Intermittent Versus Partial REBOA for Prolonged Hemorrhage Control – Annals of Emergency Medicine
https://www.annemergmed.com/article/S0196-0644(19)30975-8/abstract
[6] [7] [8] Front Line Medical Technologies Expands Availability of its COBRA-OS® | DAIC
[9] [10] Front Line Medical Technologies Announces the Release of First Real-World Data of the COBRA-OS®® for Postpartum Hemorrhage
[11] Understanding Arterial Occlusion System Use for Safer Postpartum Hemorrhage Treatment
