Case Summary: REBOA Use in the Multisystem Trauma Patient With Traumatic Brain Injury

Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a valuable adjunct in non-compressible torso hemorrhage (NCTH), improving central perfusion during hemorrhagic shock. It may offers a less invasive alternative to resuscitative thoracotomy. While matched studies suggest survival benefit, REBOA use in TBI patients remains a debate with concerns of exacerbating cerebral edema via increased afterload and perfusion pressure.


Description: A 28-year-old male sustained multisystem blunt trauma after a motorcycle vs truck collision. He presented GCS 3T, fixed pupils, flail chest, open-book pelvis, and class IV hemorrhagic shock. Chest tubes and pelvic binder were placed while MTP was initiated. Despite initial stabilization, hypotension persisted. A 7F sheath was placed in the left femoral artery and REBOA catheter inserted to zone 3; balloon inflation was deferred due systolic BP 120. CT revealed pelvic hemorrhage, epidural hematoma causing cerebral compression. Patient became hypotensive so the REBOA balloon was inflated, improving SBP. This allowed for craniectomy and IR pelvic embolization. The balloon was deflated after 56 minutes. Despite multispecialty intervention, the patient was declared brain-dead on hospital day 2 and organ donation was pursued.


Discussion: This case demonstrates the utility of zone 3 REBOA as a bridge in blunt trauma with hemorrhagic shock and severe TBI. While REBOA in TBI is controversial, growing data suggest, selective use with short occlusion times may stabilize patients long enough to permit critical interventions. Elkbuli et al. (2024) showed increased mortality in TBI patients receiving REBOA, likely due to loss of cerebral autoregulation. However, Nordham et al. (2023), Hsu et al. (2024), and Brenner et al. (2022) report no worsened neurologic outcomes with REBOA in carefully selected TBI patients. Zone 3 occlusion is associated with less intracranial pressure rise than zone 1 (Tibbits, 2018), and partial REBOA may further mitigate cerebral risks (Shah et al., 2025). In this case, REBOA enabled resuscitation and surgical stabilization despite poor neurologic prognosis. It underscores REBOA’s role as a temporizing measure—not contraindicated in TBI, but requiring careful zone selection, time control, and multidisciplinary coordination.