Temporary hemodynamic response with resuscitative endovascular balloon occlusion of the aorta (REBOA) during cardiopulmonary resuscitation in a case of traumatic cardiac arrest.

Uncontrolled hemorrhagic shock due to trauma is a life-threatening condition requiring rapid intervention. Every minute in the man-agement of these patients is valuable. In recent years, resuscitative endovascular aortic balloon occlusion (REBOA) has emerged as a valuable tool in emergency and trauma practice, providing additional time for the patient, particularly in cases where surgical hemosta-sis is delayed. A 62-year-old male patient with no known comorbidities was transported to our tertiary trauma center after receiving five minutes of cardiopulmonary resuscitation (CPR) and intubation at an external facility following a high-energy traffic accident. Upon presentation, the patient's blood pressure was 50/20 mmHg and pulse rate was 128 beats/min. He had extensive pelvic trauma, lower extremity trauma, major soft tissue loss, and vascular and bone injuries. He underwent hemostatic resuscitation along with whole-body computed tomography (CT) imaging; however, cardiac arrest recurred after imaging. During CPR, simultaneous imaging studies revealed no trauma or bleeding in the brain or thorax. REBOA was planned for the patient. Temporary return of spontaneous circula-tion (ROSC) was achieved 38 minutes after REBOA. During this period, the patient received a total of six units of packed red blood cells, three units of fresh frozen plasma, two units of cryoprecipitate, and calcium replacement. The REBOA procedure was performed by emergency physicians and cardiovascular surgeons who had received hands-on training using a REBOA simulation model developed by our team. However, despite achieving a temporary hemodynamic response, the patient could not be stabilized for surgical interven-tion and was pronounced deceased. In this case, we share the first REBOA experience of emergency department physicians trained with a locally produced simulation model. We believe that simulation-based training will contribute to physician experience and direct field application in rare or rapidly evolving emergencies.