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Aug 2026

In-flight resuscitative endovascular balloon occlusion of the aorta (REBOA): Testing the limits of endovascular care in hHelicopter emergency medical services.

BACKGROUND Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used to control non-compressible torso hemorrhage in advanced trauma systems. However, its feasibility during active helicopter transport remains unclear. This study evaluated whether trained Helicopter Emergency Medical Services (HEMS) teams can perform REBOA in flight under realistic conditions. METHODS A prospective high-fidelity simulation study was conducted with fourteen HEMS clinicians organized into seven physician-nurse teams. Standardized hemorrhagic shock scenarios were performed in full-motion helicopter simulators replicating AW109 and Bell 412 cabins. The primary outcome was successful in-flight REBOA deployment. Secondary outcomes included time to balloon inflation, first-attempt success, and procedural performance using the Objective Structured Assessment of Prehospital REBOA Application (OSAPRA). RESULTS Successful deployment was achieved in all simulations (100%). Median time to balloon inflation was 7:32 min. First-attempt success occurred in 78.6% of cases. Higher OSAPRA scores were associated with shorter procedural times. Inflation times were shorter in the AW109 compared to the Bell 412, although overall success was similar. CONCLUSIONS In-flight REBOA deployment is technically feasible in high-fidelity simulation. Operator competence and cabin configuration may influence performance, supporting further research prior to clinical implementation.

Antonio Martínez García, I. Ortega-Deballon, J. Roldán et al. · 0 citations
Review Jul 2026

Prehospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and cardiac arrest: a systematic review.

OBJECTIVES Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides temporary hemorrhage control and optimizes perfusion to vital organs. Despite increasing use in civilian and combat prehospital settings, there is limited consensus on its application or effectiveness. Research has shown mixed effects on mid- to long-term survival, and the inherently high mortality risk among patients receiving REBOA complicates the interpretation of literature. This systematic review consolidates evidence on REBOA use in prehospital and transport medicine settings. METHODS We conducted a systematic review of multiple databases to identify studies describing REBOA use in the prehospital or transport medicine setting. Two independent reviewers screened against inclusion and exclusion criteria. The risk of bias was assessed via the ROBINS-I tool. The primary outcomes were feasibility of REBOA and survival rates. Secondary outcomes included complications and other ​​relevant safety outcomes. Owing to anticipated heterogeneity, a narrative synthesis was conducted. RESULTS The search yielded 1,211 articles, 31 registered trials, and 151 conference abstracts, of which 14 case studies, two prospective cohort studies, one retrospective chart review, one clinical trial, and four registered trials met the inclusion criteria. The included studies were of critical to serious risk of bias due to inherent methodological limitations. When attempted, prehospital REBOA was successfully deployed in 29/38 (76%) of civilian trauma cases, 76/90 (84%) of civilian nontraumatic cardiac arrest cases, and 2/2 (100%) of combat trauma cases. All out-of-hospital cardiac arrest (OHCA) studies reported significant elevation of blood pressure or EtCO2 following REBOA, although survival rates and complications varied widely. When reported, survival to hospital discharge was 44% (14/32) in civilian trauma cases, 4% (1/25) in civilian OHCA cases, and 88% (7/8) in civilian interfacility transport cases. No survival data were available for REBOA in combat cases. Survival rates were correlated with patient selection criteria and the nature of injuries. CONCLUSIONS The current evidence for REBOA use in the prehospital and transport medicine settings is limited by the small number of cases in most existing studies, the lack of control groups in all but one study, and limited reporting of patient-focused outcomes.

Devlyn Sun, Pierre-Marc Dion, Matthew Olejarz et al. · 0 citations
Open access Aug 2026

Pulsatile Intravascular Lithotripsy for Heavily Calcified Femoropopliteal Arterial Disease: First-in-Human Results from the POWER PAD I Feasibility Study

Background/Objectives: Severe arterial calcification remains a major challenge during femoropopliteal endovascular intervention, limiting luminal gain and increasing the risk of vessel-wall injury, restenosis, and bailout stenting. Pulsatile intravascular lithotripsy (PIVL) is a novel calcium-modification technology that converts pneumatic pulses into short-duration hydraulic pressure waves delivered through a non-compliant balloon. POWER PAD I evaluated the first-in-human feasibility, safety, and procedural performance of PIVL in calcified femoropopliteal arterial disease. Methods: POWER PAD I was a prospective, single-arm, two-center feasibility study. Adults with Rutherford category 2–4 symptomatic peripheral arterial disease and moderately or severely calcified superficial femoral or popliteal lesions were treated with PIVL, followed by adjunctive therapy when clinically indicated. Angiographic and duplex ultrasound outcomes were assessed by an independent core laboratory, and adverse events were adjudicated by an independent clinical events committee. Results: Nine patients underwent treatment of 20 lesions. Mean age was 76.2 ± 12.6 years, 19 lesions were severely calcified, and five lesions were chronic total occlusions. Patient-level device and procedural success were each achieved in 8 of 9 patients; technical success was achieved in all patients. Mean diameter stenosis decreased from 76.5 ± 18.0% before treatment to 28.1 ± 6.9% after PIVL-containing lesion preparation and before adjunctive drug-coated-balloon angioplasty, and to 20.6 ± 5.8% after adjunctive therapy. Mean minimal luminal diameter increased from 1.3 ± 1.0 mm to 3.8 ± 0.5 mm after PIVL-containing lesion preparation and to 4.3 ± 0.6 mm at final angiography. No perforation, distal embolization, thrombus, abrupt closure, no-reflow, bailout stenting, or grade D or higher dissection occurred. Freedom from clinically driven target-lesion revascularization was 100% at 30 days and 6 months. Conclusions: PIVL-containing lesion preparation was feasible in heavily calcified superficial femoral and popliteal lesions and was associated with substantial acute luminal gain before adjunctive DCB therapy and no severe angiographic complications. Favorable 6-month clinical and patency outcomes were observed after the combined treatment strategy of PIVL vessel preparation and adjunctive DCB therapy; therefore, longer-term outcomes cannot be attributed to PIVL alone. Larger controlled studies are warranted.

B. Mwipatayi, Bernardette Jingfei Lee, Davina Daudu et al. · 0 citations
Review Aug 2026

Autonomous Vascular Access Devices: Current Solutions and Future Challenges.

Autonomous or semi‑autonomous "autonomous vascular access" (AVA) platforms have the promise to standardize technique, accelerate placement by a wider range of providers, extend cannulation capability to austere settings, and reduce complication‑related morbidity.

Joel Grunhut, Patrick Walker, Meredith Lackie et al. · 0 citations
Open access Aug 2026

Temporary flow arrest using EMBOGUARD™ balloon guide catheter may improve functional outcomes in acute stroke thrombectomy: a multicenter retrospective study

Balloon guide catheters (BGCs) have demonstrated benefits in mechanical thrombectomy (MT) for acute ischemic stroke (AIS), including improved recanalization rates and reduced distal embolization. The EMBOGUARD™ balloon guide catheter (Johnson & Johnson Neurovascular, Irvine, CA) represents a novel design with enhanced flexibility and compatibility with large-bore aspiration catheters. This study aims to evaluate the safety and efficacy of the EMBOGUARD™ BGC compared with non-BGC approaches. We conducted a retrospective multicenter study to analyze patients with AIS due to anterior large vessel occlusions (LVOs) who underwent MT between January 2022 and December 2024. Patients were divided into two groups: those treated with t☺he EMBOGUARD™ BGC and those treated without BGC. Primary outcomes included first-pass effect (FPE), successful recanalization (mTICI ≥2b), procedural time, number of passes, and distal embolization. Secondary outcomes included 90-day functional outcome (modified Rankin Scale [mRS] 0–2), mortality, and symptomatic intracranial hemorrhage (sICH). A total of 178 patients were included (EMBOGUARD: n  = 135, 75.8%; non-BGC: n  = 43, 24.2%). The EMBOGUARD™ group demonstrated comparable rates of FPE (33.3% vs. 37.2%, p  = 0.68) and successful recanalization (86.7% vs. 86.0%, p  = 0.92). Procedural time was significantly shorter in the EMBOGUARD™ group (median 32 min vs. 49 min, p  = 0.004). Distal embolization rates were similar between groups (4.4% vs. 4.7%, p  = 1.00). The EMBOGUARD™ group showed significantly higher rates of favorable functional outcome at 90 days (48.6% vs. 28.1%, p  = 0.04) and non-significantly lower 90-day mortality (13.7% vs. 16.7%, p  = 0.6). Although favorably trending, multivariate logistic regression analysis did not confirm that EMBOGUARD™ was associated with greater odds of FPE (adjusted odds ratio [aOR] 2.01, 95% confidence interval [CI] 0.65–6.41, p  = 0.2), mRS 0–2 at 90 days (aOR 1.36, 95% CI 0.35–5.34, p  = 0.7) or lower odds of mortality at 90 days (aOR 0.32, 95% CI 0.05–1.85, p  = 0.2). The EMBOGUARD™ balloon guide catheter demonstrated comparable technical efficacy with reduced procedural times and improved clinical outcomes compared with non-BGC techniques in endovascular thrombectomy for acute ischemic stroke. These findings support the use of EMBOGUARD™ as a reasonable tool for flow arrest in stroke intervention.

R. Morsi, S. Falk, Elena Badillo Goicoechea et al. · 0 citations
Review Aug 2026

Flow arrest in intracranial aneurysm surgery: Temporary clip, adenosine, rapid ventricular pacing, and balloon test occlusion - A narrative review.

Precise and controlled interruption of cerebral blood flow is essential in modern cerebrovascular surgery, where safe manipulation of aneurysms often depends on creating short intervals of reduced perfusion. A variety of strategies (temporary arterial clipping, adenosine-induced transient circulatory arrest, rapid ventricular pacing, and balloon test occlusion) provide distinct mechanisms for achieving flow arrest, each with unique advantages, limitations, and optimal clinical contexts. Although the use of flow-arrest-assisted neurosurgery has become increasingly rare, it remains an important adjunct in selected cases, where detailed knowledge of these techniques can be indispensable for safe and effective treatment. This narrative review synthesizes current knowledge on the physiological basis, technical execution, and perioperative considerations of these four principal modalities. Taken together, these techniques allow hemodynamic control in a wide spectrum of neurovascular interventions. A nuanced understanding of their mechanisms and indications is essential for minimizing ischemic risk, optimizing surgical exposure, and improving patient outcomes.

A. Dębska, Bartosz M. Szmyd, N. Koc et al. · 0 citations

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