Lit Matters 3: REBOA vs thoracotomy in traumatic cardiac arrest

Traumatic cardiac arrest from infradiaphragmatic truncal hemorrhage still has grim survival, and rapid aortic control remains the central decision. In trauma-center data, REBOA and resuscitative thoracotomy had similar in-hospital mortality, with REBOA trading invasiveness for slower time to occlusion.

Aortic Control in Traumatic Arrest

• Neutral mortality signal: In traumatic cardiac arrest, REBOA and resuscitative thoracotomy showed similar in-hospital mortality rather than a clear winner, a useful reset if you have treated REBOA as automatically superior.
• Time to occlusion tradeoff: REBOA took longer to achieve aortic occlusion than thoracotomy, which matters when arrest physiology leaves little margin for delay. We get into why that timing difference changes bedside thinking in the episode.
• Procedure failure reality: REBOA was not universally successful; several placements failed and some patients were converted to thoracotomy, reinforcing that backup plans matter before you commit to an endovascular-first approach.
• Below-diaphragm hemorrhage frame: The comparison applies to suspected truncal bleeding below the diaphragm, where the decision is less about elegance and more about the fastest credible path to proximal hemorrhage control.
• Trauma center versus community: The likely niche for REBOA may be the community hospital that can rapidly transfer to a trauma center, but that system-level advantage remains plausible rather than proven in rigorous study.