BackgroundCirculatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.MethodsSystematic review and meta-analysis (1900–2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords “aortic balloon occlusion”, “aortic balloon tamponade”, “REBOA”, and “Resuscitative Endovascular Balloon Occlusion” in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.ResultsA total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.ConclusionREBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.Electronic supplementary materialThe online version of this article (10.1007/s00068-018-0959-y) contains supplementary material, which is available to authorized users.

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The objective of the study was first to quantify the level of pain that patients experience during VNUS ClosureFAST™ and in the first week following treatment. Secondly, to investigate the use of pain medication. Thirdly, to identify after how many days patients return to daily activities and whether pain is a factor of influence. A prospective descriptive cohort study was carried out. In all, 104 consecutive VNUS ClosureFAST procedures for greater saphenous vein (GSV) incompetence between 18 May and 28 August 2009 in the HagaZiekenhuis were included. A visual analogue score (VAS) was recorded immediately after the procedure. These patients were asked to register pain scores during the week following the procedure, the amount of pain medication if used and the time elapsed between the procedures and resuming daily activities. The average VAS score during the VNUS Closure procedure was four. The first three days after the procedure the VAS score was 2. After four days, the average score was 1. The average return to daily activities was on day two after the procedure. In total, 24% of all patients used paracetamol after the procedure. In summary, VNUS ClosureFAST procedure for GSV incompetence is not a painless treatment. After an average of two days, patients return to their daily activities. Pain does not seem to be a major factor in the resumption. Seventy-six percent of patients do not use any pain medication.

This comprehensive training model using a live tissue-simulator hybrid porcine model can be used for femoral access and REBOA placement training in medical personnel with different prior training levels. Higher levels of training are associated with faster procedure times. Further research in open and percutaneous access training is necessary to simulate real-life situations. This training method can be used in a multistep training programme, in combination with realistic moulage and perfused cadaver models.

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