A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination

Abstract

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.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

“…After subsequent duplication removal, primary and secondary screening analysis based on inclusion and exclusion criteria, 105 articles were included in the study (figure 1). 3 11–70 A large proportion of articles were retrospective. 13 studies were case reports, and 10 were prospective observational studies (figure 2).…”

REBOA: Where are we now?

“…The military also describe impressive and successful case reports . A meta‐analysis of REBOA and another of REBOA and open aortic cross clamping together with an early REBOA registry report all suggested positive effects on outcomes and are broadly supportive. There followed a statement from the American College of Surgeons highlighting indications, guidelines and complications.…”

Colonic ischemia possibly due to resuscitative endovascular balloon occlusion of the aorta (REBOA) used to manage amniotic fluid embolism: a case report

“…REBOA is widely considered to be a minimally invasive and safe technique. A recent systematic review reported a rate of iatrogenic injury related to REBOA of < 5% [5]. Meanwhile, the potential risks of REBOA have also been indicated.…”