SOC → SCF-DBI Logic Translation

Purpose

REBOA is a temporary endovascular hemorrhage-control intervention used to stabilize patients with non-compressible torso hemorrhage by inflating a balloon within the aorta to reduce distal blood flow and preserve perfusion to the heart and brain.

SOC Definition

Clinical Objective

Temporarily interrupt distal hemorrhage while maintaining:

• Coronary perfusion
• Cerebral perfusion
• Central arterial pressure

REBOA serves as a bridge to:

• Damage-Control Surgery (DCS)
• Interventional Radiology (IR)
• Definitive hemorrhage control

SOC Logic

Problem

Massive hemorrhage causes:

• Reduced circulating volume
• Reduced cardiac output
• Reduced cerebral perfusion
• Reduced coronary perfusion

Intervention

Inflate an aortic balloon proximal to bleeding source.

Result:

• Distal flow reduction
• Increased proximal perfusion pressure
• Temporary stabilization

SCF-DBI Translation

Core Concept

SOC views REBOA as:

Mechanical hemorrhage control.

SCF-DBI views REBOA as:

Temporary Perfusion Redistribution Architecture.

REBOA does not stop physiologic collapse.

It temporarily shifts perfusion priorities toward critical organ preservation.

SCF-DBI Perfusion Hierarchy Model

Priority 1

Brain Preservation

Maintain:

• Cerebral blood flow
• Oxygen delivery
• Neuroelectrical viability

Priority 2

Cardiac Preservation

Maintain:

• Coronary perfusion
• Myocardial oxygenation
• Contractile reserve

Priority 3

Visceral Preservation

Maintain survivable ischemic burden until hemorrhage control.

Priority 4

Extremity Preservation

Lowest priority during active exsanguination.

Aortic Zone Architecture

Zone I

Location

Left subclavian artery → celiac artery

SOC Use

Intra-abdominal hemorrhage

SCF-DBI Translation

Global Perfusion Salvage Zone

Preserves:

• Brain
• Heart

at the expense of:

• Abdominal organs
• Kidneys
• Lower extremities

Zone III

Location

Infrarenal aorta

SOC Use

Pelvic hemorrhage

SCF-DBI Translation

Pelvic Perfusion Isolation Zone

Preserves:

• Brain
• Heart
• Abdominal organs

while reducing:

• Pelvic arterial bleeding

SCF-DBI Ischemia Burden Assessment

Major Enhancement Beyond SOC

SOC monitors:

• Blood pressure
• Hemorrhage control

SCF-DBI additionally monitors:

Ischemic Debt Accumulation

Every minute of balloon inflation creates downstream ischemic burden.

Ischemic Debt Domains

DBI Logic

REBOA creates:

Perfusion Preservation

and simultaneously

Ischemic Debt Accumulation

The procedure is therefore a balance between:

• Immediate survival benefit
• Future reperfusion injury risk

SCF-DBI Enhancement

Ischemia-Reperfusion Biomarker Surveillance

Purpose

Predict reperfusion injury before balloon deflation.

This represents the principal SCF-DBI enhancement to conventional REBOA management.

Biomarker Surveillance Panel

Metabolic Injury

Muscle Injury

Renal Injury

Hepatic Injury

Cellular Injury

Balloon Deflation Readiness Assessment

SOC

Deflate after hemorrhage control.

SCF-DBI

Assess physiologic readiness before reperfusion.

Reperfusion Risk Categories

Reperfusion Collapse Model

Mechanism

Balloon deflation causes:

Phase 1

Release of:

• Lactate
• Potassium
• Acid metabolites

Phase 2

Systemic vasodilation

Phase 3

Myocardial depression

Phase 4

Reperfusion inflammatory surge

Phase 5

Potential cardiovascular collapse

SCF-DBI REBOA Workflow

Step 1

Identify non-compressible torso hemorrhage.

Output

REBOA Eligibility Score

Step 2

Determine aortic zone.

Output

Perfusion Redistribution Map

Step 3

Deploy balloon.

Output

Hemorrhage Stabilization Score

Step 4

Monitor ischemic debt.

Output

Ischemic Burden Index

Step 5

Perform biomarker surveillance.

Output

Reperfusion Risk Score

Step 6

Achieve definitive hemorrhage control.

Output

Source Control Confirmation

Step 7

Assess balloon deflation readiness.

Output

Deflation Readiness Score

Step 8

Controlled reperfusion.

Output

Reperfusion Stability Index

Step 9

Post-deflation surveillance.

Output

Organ Recovery Profile

Glossary

SCF Principle Alignment

INDEX

SCF-SURG-REBOA-0001

SCF-DBI-PERFUSION-REDISTRIBUTION-0001

SCF-DBI-ISCHEMIC-DEBT-0001

SCF-DBI-REPERFUSION-RISK-0001

SCF-DBI-BALLOON-DEFLATION-READINESS-0001

SCF-TRAUMA-ENDOVASCULAR-WORKFLOW-0005

SCF-REBOA-MASTER-PROTOCOL-0001