Resuscitative endovascular balloon occlusion of the aorta (REBOA) in interhospital trauma care: A case report enabled by real-time information coordination

Rationale: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a key skill for managing noncompressible torso hemorrhage, but its use in prehospital transport remains controversial due to potential ischemic complications. The feasibility of REBOA during complex interhospital transfers, particularly in remote settings, requires further illustration. Patient concerns: A 51-year-old male presented with hemorrhagic shock (blood pressure 44/22 mm Hg, heart rate 160 bpm, cold peripheries) following a road traffic accident causing an open pelvic fracture and right femoral shaft fracture. Diagnoses: Open pelvic fracture, right femoral shaft fracture, and traumatic hemorrhagic shock. Injury Severity Score was 17. Interventions: Partial REBOA was performed in an ambulance during interhospital transport, enabled by a regional real-time 5G-based medical information coordination system that facilitated dynamic ambulance rendezvous and remote consultation. A 14 mm ATLAS PTA balloon catheter (Bard) was advanced to zone III via a 7 Fr sheath (Terumo, Japan), with blood-pressure-guided partial occlusion. Outcomes: Following REBOA deployment, hemodynamics stabilized (blood pressure increased to 102/82 mm Hg), allowing safe transport and subsequent definitive surgical hemostasis. The patient survived without REBOA-related complications during the 6-month follow-up. Lessons: This case illustrates that, when supported by robust information coordination, REBOA may be feasibly and safely applied during complex interhospital transfers. It highlights the potential role of integrated telemedicine and coordination systems in extending advanced resuscitative care to challenging environments.