REBOA in Low-Resource and Austere Hemorrhage Care: A Structured Narrative Review and Readiness Framework

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered a bridge to definitive hemorrhage control when transport, operating-room access, blood, or endovascular resources are constrained. These same conditions magnify risks from failed femoral access, prolonged occlusion, ischemia, thrombosis, and delayed hemostasis. This narrative review maps evidence from prehospital systems, military and combat care, interfacility transfer, and resource-constrained trauma centers. Expert-led series demonstrate technical feasibility and proximal hemodynamic improvement, but physiologic signals should not be equated with neurologically intact survival. Traumatic cardiac arrest evidence remains sparse, heterogeneous, and predominantly uncontrolled. The UK-REBOA randomized trial found no mortality benefit and a signal toward harm. We propose a seven-domain REBOA Readiness Bundle, a competency-based training model, and a staged clinical implementation pathway. REBOA should be adopted as a governed system capability that links selection, access, resuscitation, occlusion-time control, definitive hemostasis, and vascular surveillance rather than as an isolated device.