# Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Refractory Upper Gastrointestinal Bleeding: A Case Series

## TL;DR

This paper presents three cases where REBOA was used successfully to stabilize patients with severe upper gastrointestinal bleeding when other treatments failed.

## Contribution

The novel contribution is demonstrating REBOA's potential as a safe and effective emergency treatment for refractory upper gastrointestinal bleeding in ICU settings without angiography.

## Key findings

- REBOA provided rapid circulatory stabilization in three elderly patients with refractory UGIB.
- No REBOA-related complications like organ dysfunction or ischemia were observed.
- REBOA enabled subsequent definitive hemostasis via surgical or endoscopic methods.

## Abstract

While resuscitative endovascular balloon occlusion of the aorta (REBOA) is a recognized life-saving intervention for hemorrhagic control in trauma, evidence supporting its use in managing refractory upper gastrointestinal bleeding (UGIB) is still limited. However, REBOA holds considerable potential for providing crucial hemodynamic stabilization in refractory UGIB cases where conventional therapies fail to achieve adequate hemostasis. We present cases of three elderly patients (88F, 72M, 74M) with refractory UGIB and profound hemorrhagic shock unresponsive to initial resuscitation. REBOA was emergently deployed at the bedside in the intensive care unit (ICU) using anatomical landmarks and ultrasound guidance, achieving rapid circulatory stabilization and enabling subsequent definitive hemostasis by surgical or endoscopic methods. No REBOA-related complications such as organ dysfunction or ischemia were observed. Our experience suggests REBOA may serve as a safe and effective bridge to hemostasis in select patients with refractory UGIB, even when deployed in an ICU setting without angiography. Further research is needed to establish standardized protocols and define optimal patient selection.