Journal of Trauma and Injury

Bridging the gap: a successful interhospital transfer of a bleeding pelvic fracture patient using REBOA and the “doctor car” system: a case report: Hanbyol Song, Gil Jae Lee, Byungchul Yu, Seung Hwan Lee, Min A Lee, Myung Jin Jang, Jeong Ho Kim, Kang Kook Choi; Received March 11, 2025 Accepted May 22, 2025 Published online November 20, 2025; DOI: https://doi.org/10.20408/jti.2025.0059 [Epub ahead of print]

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Abstract PDF: Severe traumatic injuries, particularly unstable pelvic fractures, frequently result in life-threatening hemorrhagic shock, necessitating urgent transfer to specialized trauma centers. However, interhospital transport of hemodynamically unstable patients poses a significant risk of clinical deterioration. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers effective temporary hemodynamic stabilization before definitive care. Here, we describe the successful use of zone III REBOA by a surgeon-staffed emergency medical service (“doctor car”) to rapidly stabilize and safely transfer a 62-year-old man with a severe bleeding pelvic fracture. Upon arrival at the trauma center, the patient underwent immediate definitive treatments, including preperitoneal pelvic packing and transarterial embolization. This case highlights the potential for integrating REBOA with physician-staffed emergency transport systems as a strategy to bridge critical gaps in regional trauma care networks and improve patient outcomes.; Summary

Quality monitoring of resuscitative endovascular balloon occlusion of the aorta using cumulative sum analysis in Korea: a case series: Hyunsik Choi, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Wu Seong Kang; J Trauma Inj. 2023;36(2):78-86. Published online December 21, 2022; DOI: https://doi.org/10.20408/jti.2022.0069

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Purpose
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a state-of-the-art lifesaving procedure. However, due to its high mortality and morbidity, including ischemia and reperfusion injury, well-trained medical staff and effective systems are needed. This study was conducted to investigate the learning curve for REBOA.
Methods
To monitor this learning curve, we used cumulative sum (CUSUM) analysis and graphs of mortality and aortic occlusion time within 60, 90, and 120 minutes for consecutive patients. The procedures performed between July 2017 and June 2021 were divided into pre-trauma center (pre-TC; July 2017–February 2020) and TC (February 2020–June 2021) periods.
Results
REBOA was performed for 31 consecutive patients with trauma. The pre-TC (n=12) and TC (n=19) periods did not differ significantly with regard to Injury Severity Score, age, injury mechanism, initial systolic blood pressure, prehospital cardiopulmonary resuscitation (CPR), or CPR in the emergency department. At the 17th consecutive patient during the TC period, CUSUM failure graphs for mortality and aortic occlusion time exhibited a downward inflection, indicating an improvement in performance.
Conclusions
The mortality and aortic occlusion time of REBOA improved, and these parameters can be monitored using CUSUM analysis at the hospital level.

Summary

Citations

Citations to this article as recorded by

Emergency department laparotomy for patients with severe abdominal trauma: a retrospective study at a single regional trauma center in Korea
Yu Jin Lee, Soon Tak Jeong, Joongsuck Kim, Kwanghee Yeo, Ohsang Kwon, Kyounghwan Kim, Sung Jin Park, Jihun Gwak, Wu Seong Kang
Journal of Trauma and Injury.2024; 37(1): 20. CrossRef
Nonselective versus Selective Angioembolization for Trauma Patients with Pelvic Injuries Accompanied by Hemorrhage: A Meta-Analysis
Hyunseok Jang, Soon Tak Jeong, Yun Chul Park, Wu Seong Kang
Medicina.2023; 59(8): 1492. CrossRef

Merit of Zone III Resuscitative Endovascular Occlusion of the Aorta under Real-Time Fluoroscopy in Hybrid ER: A Case of REBOA in Traumatic Cardiac Arrest: Sung Do Lee, Seungwoo Chung, Young Jun Ki, Sang Hyun Seo, Chan Yong Park; J Trauma Inj. 2020;33(3):191-194. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0054

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Abstract PDF: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a novel technique to maintain proximal arterial pressure. It is important to locate the balloon catheter correctly in performing REBOA but it is inaccurate to check the catheter position by external measurement. Even if the position of the catheter is initially confirmed by X-ray, it is difficult to determine the location of the catheter that changes according to various situations. We performed REBOA under real-time fluoroscopy and could maintain the catheter in correct position under various situations.; Summary

External Iliac Artery Transection Managed by Iliofemoral Bypass Grafting Using Temporary Balloon Occlusion: Young Un Choi, Jae Gil Lee, Kwangmin Kim, Seongyup Kim, Keumseok Bae, Ji Young Jang, Pil Young Jung, Hongjin Shim, Young Jin Youn, Il Hwan Park; J Trauma Inj. 2017;30(4):242-246. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.242

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Abstract PDF: Traumatic abdominal vessel injury is rare, but difficult to manage. Approaching the injured vessel and controlling the bleeding is very hard. We experienced the right iliac artery transection managed by iliofemoral bypass grafting using temporary balloon occlusion. Proximal occlusion of an iliac artery with a temporary balloon cab be an option or bridge technique for a definite operation in case of iliac artery rupture. So, we present our case.; Summary

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