Resuscitative Thoracotomy and Aortic Cross-Clamp and Resuscitative Endovascular Balloon Occlusion of the Aorta


  • Futoshi Nagashima Department of Emergency and Critical Care Medicine, Toyooka Public Hospital
  • Takayuki Irahara Advanced Critical Care Center, Aichi Medical University Hospital
  • Kenichiro Ishida Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital
  • Takaaki Maruhashi Department of Emergency and Critical Care Medicine, Kitasato University school of Medicine
  • Yosuke Matsumura Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine


Resuscitative thoracotomy and aortic cross-clamp (RTACC), Resuscitative endovascular balloon occlusion of the aorta (REBOA)


There are three methods of aortic occlusion; RTACC (resuscitative thoracotomy with aortic cross-clamp), abdominal aortic compression/occlusion after laparotomy, and REBOA. It is essential to understand the characteristics of each methods and use them appropriately according to the situation or in combination. RTACC is characterized by its rapidity and certainty, but highly invasive. Abdominal aortic compression/occlusion is beneficial because hemostasis after laparotomy can be performed simultaneusly. Advantages of REBOA compared to RTACC are minimaly-invasiveness and safety, and disadvantages are rapidity and certainty. However, it is not necessary to discuss the superiority or inferiority of RTACC and REBOA. The appropriate determination of a combination of these tactics will increase the range of strategies. In particular, RTACC should be performed promptly for impending cardiac arrest and early conversion to REBOA can be helpful regarding to prevention of hypothermia and reduction of chest wall bleeding (To "REBOA & RTACC" instead of "REBOA vs RTACC").


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Narrative Review Article