A DELPHI CONSENSUS ALGORITHM FOR MODERN REBOA PROGRAMS: EMPLOYING A TITRATABLE CATHETER AND PARTIAL AORTIC OCCLUSION TO ADVANCE THE PROCEDURE

Abstract

Background: Technical advances in REBOA catheters have made partial aortic occlusion a more common hemorrhage mitigation strategy in trauma resuscitation. This technique balances hemorrhage control and distal ischemic concerns; however, there are limited data to guide best practices. We aim to provide a pragmatic guideline, based on expert consensus, on the use of pREBOA and partial aortic occlusion for modern REBOA programs. Methods: A Delphi study was conducted based on 12 experts experienced in pREBOA and partial aortic occlusion. An initial questionnaire was distributed and results anonymously collated into consensus statements. These statements were then anonymously distributed and refined to reach 80% consensus. Results: After the initial questionnaire and two rounds of polling, a total of 15 consensus statements were developed, all reaching >80% agreement. These statements focused around REBOA program development, early common femoral arterial access, REBOA placement, management, and occlusion/reperfusion strategies. Conclusion: This Delphi study provides guidance on how to leverage pREBOA and partial aortic occlusion as a resuscitative adjunct. It addresses thresholds for common femoral arterial access, triggers for occlusion, complete versus partial aortic occlusion, computed tomography imaging, pREBOA with thoracic injuries, proximal and distal blood pressure goals, updated ischemia times, strategies for reperfusion, and sheath management. This algorithm provides a framework for the development of REBOA programs that encompasses new REBOA technologies with partial aortic occlusion and guides the user from patient presentation to sheath removal in a modern era.