Evaluating Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Battlefield Trauma: A Comparative Analysis of Commercially Available Catheters.

INTRODUCTION: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a minimally invasive method to control noncompressible torso hemorrhage, now integral to military damage control resuscitation. Modern combat conditions may create mixed inventories of REBOA catheters that differ in balloon compliance, flow modulation, and monitoring capability. Understanding device-specific performance is essential for safe use and informed procurement. MATERIALS AND METHODS: We conducted a head-to-head evaluation of 3 FDA-cleared, combat-deployable REBOA catheters: ER REBOA PLUS, pREBOA PRO, and COBRA OS. Testing used a custom pulsatile flow loop that simulated physiologic pressures, flows, and vessel dynamics. Devices were assessed for their ability to achieve complete Zone 1 occlusion, provide accurate pressure readings, correlate distal pulsatility and mean arterial pressure with true flow, and maintain controlled partial occlusion during simulated vasomotor and heart rate changes. Each system's logistical footprint, including mass and cube, was measured in field and packaged configurations. RESULTS: ER REBOA PLUS and pREBOA PRO achieved complete Zone 1 occlusion across aortic diameters up to 26 mm, while COBRA OS did not occlude above 22 mm. Only pREBOA PRO maintained stable partial flow with minimal drift during simulated vasoconstriction, vasodilation, and heart rate variation. The compliant balloons of ER REBOA PLUS and COBRA OS transmitted distal pulsatility despite negligible flow, indicating that pressure or waveform alone may misrepresent perfusion. pREBOA PRO demonstrated the most controllable flow response and strongest correlation between distal pressure and true flow. COBRA OS offered the lowest mass and volume but lacked integrated pressure monitoring and reliable partial REBOA function. CONCLUSIONS: pREBOA PRO provided the most controllable partial occlusion and stable pressure flow relationship, supporting its use when prolonged occlusion or partial REBOA is anticipated. ER REBOA PLUS and COBRA OS remain suitable for short-duration complete occlusion but not for pressure-guided partial REBOA.