The present paper describes three cases where ER-REBOA® was used with partial aorta occlusion (AO), by performing a partial resuscitative endovascular balloon occlusion of the aorta or pREBOA, in an austere pre-hospital military environment. In addition, because no specific REBOA algorithm for pre-hospital environment exists yet, this paper seeks to fill this gap, proposing a new pragmatic REBOA algorithm. Belgian Special Operations Surgical Team applied REBOA in three patients according to a decisional algorithm, based on the MIST acronym used for trauma patients. Only 3 ml, in the first instance, was inflated in the balloon to get AO. The balloon was then progressively deflated, and reperfusion was tracked through changes of end-tidal carbon dioxide (EtCO2). Systolic blood pressure (SBP) before ER-REBOA® placement was not higher than 60 mmHg. However, within the first 5 min after AO, SBP improved in all three cases. Due to the aortic compliance, a self-made pREBOA was progressively achieved while proximal SBP was raising with intravenous fluid infusion. Afterwards, during deflation, a steep inflection point was observed in SBP and EtCO2. ER-REBOA® is suitable for use in an austere pre-hospital environment. The MIST acronym can be helpful to select the patients for which it could be beneficial. REBOA can also be performed with pREBOA in a dynamic approach, inflating only 3 mL in the balloon and using the aortic compliance. Furthermore, while proximal SBP can be convenient to follow the occlusion, EtCO2 can be seen as an easy and interesting marker to follow the reperfusion.

In the seventeenth century, opportunities to discover chyle came about through the revival of vivisection. Gaspare Aselli discovered chyle vessels in a living well-fed dog in 1622. He introduced the term 'lacteals' or milky veins. According to Aselli, the lacteals passed through a mesenteric gland which he called 'pancreas'. The 1627 edition of Aselli's booklet was the start of a 'lymphomania', which led to the dissection and vivisection of hundreds of animals, with the University of Leiden being the clear leader in this field. The prominent researchers in Leiden were Jacobus Sylvius and Johannes Walaeus, who performed diverse experiments to support Harvey's theories on systemic circulation, and to find out the correct anatomy and physiology of lacteals and mesenteric glands. Another centre of excellence was Padua, where Veslingius and Wirsüng introduced the idea of the prominent role of the 'real pancreas', and its duct in the transformation of digested food into clear chyle. The idea of the transport of chyle to the liver was an additional support for Galen's theories regarding the function of the liver. Nevertheless, as time went on, there were fewer and fewer believers in Galenic doctrine.