First successful emergency room application of resuscitative endovascular balloon occlusion of the aorta (REBOA) in severe postpartum hemorrhage in South Korea: a case report

Abstract

Background: Postpartum hemorrhage (PPH) is a critical obstetric emergency that may lead to significant maternal morbidity and mortality. Severe PPH, defined as substantial blood loss and the need for multiple blood transfusions, requires immediate and effective intervention to prevent rapid deterioration and death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a novel technique for the control of severe hemorrhage and stabilization of patients in critical conditions, including those with severe PPH. Case: We report the case of a 40-year-old primigravid patient at 40 weeks gestation who presented with uncontrollable vaginal hemorrhage following normal delivery at a rural hospital. Initial attempts at hemostasis failed, and the patient was transferred to our hospital with hemorrhagic shock. Upon arrival, her vital signs indicated severe hemodynamic instability, and arterial blood gas analysis confirmed critical acidosis and shock. An emergency medicine physician requested that the trauma team initiate REBOA. A trauma surgeon inserted a balloon catheter into the right femoral artery and positioned the balloon in zone 1, achieving immediate hemodynamic stabilization. The balloon was later repositioned to zone 3 to balance perfusion and hemorrhage control. This intervention allowed for successful surgical management, including bilateral internal iliac artery ligation and hysterectomy. Despite the postoperative development of abdominal compartment syndrome and acute kidney injury, the patient recovered under intensive care, continuous renal replacement therapy, and subsequent hemodialysis. Conclusions: REBOA is a valuable adjunct to the management of severe PPH, offering rapid hemodynamic stabilization and a critical window for surgical repair. The successful outcome in this patient demonstrates its potential as an effective emergency intervention, emphasizing the importance of rapid deployment of trained personnel to improve maternal outcomes in patients with severe obstetric hemorrhage.