Podcast – REBOA with Zaf Qasim

Welcome to the St Emlyn’s Podcast, your go-to source for the latest insights, developments, and discussions in emergency medicine and critical care. Each month, Simon and Iain will bring you in-depth analysis, evidence-based practices, and practical advice to enhance your clinical practice and professional development. Whether you are a seasoned practitioner or just starting your journey in the field, our podcast aims to provide valuable knowledge and foster a community of learning and support. In this episode, we are publishing a podcast with Zaf Qasim on REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta). Zaf is a St Emlyn’s team member and Virchester alumnus although he now works over in the US having completed his critical care fellowships there some years ago. You can check his work in Pennsylvania by following him on Twitter

Zaf has forged a special interest in endovascular resuscitation and is uniquely placed to talk about this from both UK and US perspectives. We managed to get him on the podcast to talk about the practicalities and evidence behind REBOA, which is somewhat less robust than you might think.

Here in Virchester, we cannot currently perform REBOA in the ED, although it is technically possible in the interventional radiology suite/trauma theatre. I think we have few patients who might benefit from it, but I was really interested to hear what Zaf felt about REBOA in the UK setting.

Thank you for joining us, please do like and subscribe wherever you get our podcasts.

Listening Time – 27:40

REBOA in the Emergency Department


Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive technique, designed to control hemorrhage in patients with life-threatening bleeding, offers a bridge to definitive surgical intervention. This information gives some background to the information presented in the podcast.

Understanding REBOA

REBOA involves the insertion of a balloon catheter into the aorta via the femoral artery. By inflating the balloon, we can occlude the aorta, thus controlling bleeding below the point of occlusion. This procedure is particularly useful in cases of non-compressible torso haemorrhage, where traditional methods of haemorrhage control are inadequate.

Indications and Contraindications

  1. Hemorrhagic shock from pelvic fractures or abdominal bleeding.
  2. Trauma patients with signs of severe hemorrhage unresponsive to fluid resuscitation.
  3. As a temporary measure until surgical control of bleeding is achieved.
  1. Patients with known aortic pathology (e.g., aortic dissection).
  2. Significant injury above the diaphragm.
  3. Prolonged transport times where REBOA may not be beneficial.

The Procedure


Before performing REBOA, it is crucial to ensure that the patient is appropriately resuscitated and stabilized as much as possible. This includes securing the airway, ensuring adequate ventilation, and achieving initial hemodynamic stabilization.

Insertion and Inflation

  1. Vascular Access: Gain access to the common femoral artery using ultrasound guidance to minimize complications.
  2. Catheter Insertion: Insert the REBOA catheter through a sheath into the femoral artery. Advance the catheter under fluoroscopic or ultrasound guidance to the desired level in the aorta (Zone I: above the celiac artery for abdominal hemorrhage, Zone III: above the bifurcation of the iliac arteries for pelvic hemorrhage).
  3. Balloon Inflation: Inflate the balloon to occlude the aorta. This temporarily controls bleeding and allows time for definitive surgical repair.

Monitoring and Maintenance

Continuous monitoring of vital signs and catheter position is essential. The occlusion time should be minimized to reduce ischemic complications. Ideally, REBOA should serve as a bridge to definitive surgical intervention within 30-60 minutes.

Benefits and Challenges


  1. Rapid Hemorrhage Control: REBOA can quickly control bleeding, buying crucial time for surgical intervention.
  2. Less Invasive: Compared to traditional open thoracotomy with aortic cross-clamping, REBOA is less invasive, reducing associated morbidity.
  3. Improved Survival Rates: Emerging evidence suggests that REBOA can improve survival rates in appropriately selected trauma patients.


  1. Technical Expertise: REBOA requires specific training and expertise. Improper technique can lead to significant complications.
  2. Ischemic Complications: Prolonged aortic occlusion can lead to ischemia of distal organs and tissues, necessitating careful monitoring and timely deflation.
  3. Resource Intensive: REBOA demands resources such as fluoroscopy, ultrasound, and trained personnel, which may not be available in all settings.


REBOA represents a promising advancement in trauma care, offering a vital tool in the management of life-threatening haemorrhage, but it’s utility in the Emergency Department is uncertain.

Latest Evidence

Since the publication of this podcast, further evidence has been published.

UK – REBOA Trial

The UK-REBOA trial evaluated the effectiveness of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) in trauma patients with non-compressible torso hemorrhage. Conducted across 16 trauma centers in England, the study involved 90 patients and found that REBOA increased mortality at 90 days compared to standard care. The trial was halted early due to higher mortality and delays in definitive hemorrhage control in the REBOA group. Despite REBOA’s potential, the trial highlights the importance of timely bleeding control and experienced execution within an efficient trauma system.

Further Reading

Where to listen

You can listen to our podcast in numerous ways, ensuring you never miss an episode no matter where you are or what device you’re using. For the traditionalists, Apple Podcasts and Google Podcasts offer easy access with seamless integration across all your Apple or Android devices. Spotify and Amazon Music are perfect for those who like to mix their tunes with their talks, providing a rich listening experience. If you prefer a more curated approach, platforms like Podchaser and TuneIn specialize in personalising content to your tastes. For those on the go, Overcast and Pocket Casts offer mobile-friendly features that enhance audio quality and manage playlists effortlessly. Lastly, don’t overlook YouTube for those who appreciate a visual element with their audio content. Choose any of these platforms and enjoy our podcast in a way that suits you best!

Cite this article as: Simon Carley, "Podcast – REBOA with Zaf Qasim," in St.Emlyn's, November 14, 2019,

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