Introduction Aortic occlusion is an extreme resuscitative measure that preferentially diverts blood to the cerebral and coronary vessels, with applicability in select cases of traumatic cardiac arrest or physiological extremis. This study aims to review the outcomes of resuscitative endovascular balloon occlusion of aorta (REBOA) device use in the setting of trauma at Royal Perth Hospital. Methods A retrospective review was performed of all cases of REBOA deployment in Emergency Department for refractory shock and traumatic arrest. Data was collected from the Western Australian State Trauma Registry, between the period of January 2013 to December 2023. Patients were excluded if the REBOA was performed pre-hospital, for non-traumatic mechanisms, or not performed in the ED. Results Overall, 12 patients were included in the study, with 7 survivors (58.3%) and 5 deaths (41.7%), all in the setting of blunt trauma. During this time, more than 8000 major trauma patients presented to the hospital. Among survivors, patients were more likely to be male (n = 7 vs 3), younger (age 39.1 years ± 16.9 vs 47.6 ± 24.3), and have a higher pre-hospital systolic blood pressure (83 ± 24.4 vs 71 ± 42.3). The mortality group were more likely to have a lower index haemoglobin (88.3 ± 3.2 vs 96.4 ± 15.7), lower pH (6.8 ± 0.1 vs 7.2 ± 0.2), and higher lactate (10.5 ± 1.2 vs 6.6 ± 3.3). No procedural complications were contributors to patient death, and no significant vascular limb complications were experienced. Conclusion REBOA has had a niche applicability in our clinical practice. Patient selection appears critical and severity of the traumatic injury predicted outcome.