A Western Trauma Association critical decisions algorithm: Resuscitative endovascular balloon occlusion of the aorta

Inaba, Kenji; Alam, Hasan B.; Brasel, Karen J.; Brenner, Megan; Brown, Carlos V R; Ciesla, David J.; Moya, Marc A. de; DuBose, Joseph J.; Moore, Ernest E.; Moore, Laura J.; Sava, Jack; Vercruysse, Gary; Martin, Matthew J.

doi:10.1097/ta.0000000000003438

Cited by 7 publications

(9 citation statements)

References 49 publications

(71 reference statements)

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“…For example, the recently published Western Trauma Association (WTA) guidelines lack a recommendation regarding SBP thresholds for patient selection. 20 As the authors note, this more general guideline should be tailored to the specific capabilities and needs of each trauma program.…”

Section: Discussionmentioning

confidence: 99%

Systematic review to evaluate algorithms for REBOA use in trauma and identify a consensus for patient selection

Maiga

Kundi²,

Morrison³

et al. 2022

Trauma Surg Acute Care Open

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BackgroundPatient selection for resuscitative endovascular balloon occlusion of the aorta (REBOA) has evolved during the last decade. A recent multicenter collaboration to implement the newest generation REBOA balloon catheter identified variability in patient selection criteria. The aims of this systematic review were to compare recent REBOA patient selection guidelines and to identify current areas of consensus and variability.MethodsIn accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of clinical practice guidelines for REBOA patient selection in trauma. Published algorithms from 2015 to 2022 and institutional guidelines from a seven-center REBOA collaboration were compiled and synthesized.ResultsTen published algorithms and seven institutional guidelines on REBOA patient selection were included. Broad consensus exists on REBOA deployment for blunt and penetrating trauma patients with non-compressible torso hemorrhage refractory to blood product resuscitation. Algorithms diverge on precise systolic blood pressure triggers for early common femoral artery access and REBOA deployment, as well as the use of REBOA for traumatic arrest and chest or extremity hemorrhage control.ConclusionAlthough our convenience sample of institutional guidelines likely underestimates patient selection variability, broad consensus exists in the published literature regarding REBOA deployment for blunt and penetrating trauma patients with hypotension not responsive to resuscitation. Several areas of patient selection variability reflect individual practice environments.Level of evidenceLevel 5, systematic review.

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Section: Discussionmentioning

confidence: 99%

Systematic review to evaluate algorithms for REBOA use in trauma and identify a consensus for patient selection

Maiga

Kundi²,

Morrison³

et al. 2022

Trauma Surg Acute Care Open

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“…Recognizing these risks, the trauma community has advocated for broad participation in dedicated endovascular training courses and participation in multicenter registries including AORTA. 1,2,22,24 The relative stability of adverse events compared with recent analyses of registry data and a prior systematic review is reassuring and is maybe a result of this advocacy and may support the safety of current REBOA practices in the hands of emergency physician and acute care surgeons.…”

Section: Discussionmentioning

confidence: 74%

“…The promising experience with REBOA in high-volume centers has put it forward as a safe and effective resuscitative adjunct-and per-haps even an alternative to resuscitative thoracotomy-in select trauma patients. 1,2 However, REBOA remains an invasive procedure with significant pitfalls, including vascular access complications. 3 Adverse events have been poorly reported across comparative studies in prior systematic reviews, 4 although registry data and meta-analysis of case series have estimated their incidence between 4% and 8%.…”

mentioning

confidence: 99%

“…Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique used to temporize non-compressible hemorrhage until definitive surgical control can be obtained. The promising experience with REBOA in high-volume centers has put it forward as a safe and effective resuscitative adjunct—and perhaps even an alternative to resuscitative thoracotomy—in select trauma patients 1,2 . However, REBOA remains an invasive procedure with significant pitfalls, including vascular access complications 3 .…”

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confidence: 99%

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Vascular access complications associated with resuscitative endovascular balloon occlusion of the aorta in adult trauma patients: A systematic review and meta-analysis

Shum-Tim

Bichara-Allard

Hopkins

et al. 2023

J Trauma Acute Care Surg

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Background Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is gaining popularity worldwide for managing hypotensive trauma patients. Vascular access complications related to REBOA placement have been reported, with some cases resulting in permanent morbidity. We aim to capitalize on the increase in literature to further describe and estimate the incidence of REBOA-associated vascular access complications in adult trauma patients. Method We searched Medline, EMBASE, Scopus and CINAHL for studies reporting vascular access complications of REBOA in adult trauma patients from inception to Oct 14, 2021. Studies reporting data from adult trauma patients who underwent REBOA insertion were eligible. Exclusion criteria included patients aged 15 and younger, non-trauma patients, non-REBOA use, non-vascular access complications and patient duplication. Study data was abstracted using the PRISMA checklist and verified independently by three reviewers. Metanalysis of proportions was performed using a random effects model with Freeman-Turkey double-arcsine transformation. Post-hoc meta-regression by year of publication, sheath-size, and geographic region was also performed. The incidence of vascular access complications from REBOA insertion was the primary outcome of interest. Subgroup analysis was performed by degree of bias, sheath size, technique of vascular access, provider specialty, geographical region, and publication year. Results 24 articles were included in the systematic review and the meta-analysis, for a total of 675 trauma patients who underwent REBOA insertion. The incidence of vascular access complications was 8% (95% CI [5%-13%]). In post-hoc meta-regression adjusting for year of publication and geographic region, the use of a smaller (7-Fr) sheath was associated with a decreased incidence of vascular access complications (OR 0.87 95CI [0.75-0.99], p = 0.046, R2 = 35%, I2 = 48%). Conclusion This study provides a benchmark for quality of care in terms of vascular access complications related to REBOA insertion in adult trauma patients. Smaller sheath size may be associated with a decrease in vascular access complications. Level of Evidence III Study type: Systematic Review and Meta-Analysis

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“…As evidence of continued interest in and refinement of REBOA, this issue of the Journal of Trauma and Acute Care Surgery features several articles on the topic, including the Western Trauma Association decision algorithm. 28 Also, in this issue, a paper by Laverty and colleagues 29 reports on a study that used the AAST AORTA registry to further the understanding of and explore ways to mitigate access-related complications associated with the procedure. Findings from the Laverty study emphasize the need for proficiency in arterial access and vigilant sheath management and highlight the promise of lower profile and partial REBOA devices.…”

Section: Current Issue Of the Journal Of Trauma And Acute Care Surgerymentioning

confidence: 99%

A contemporary assessment of resuscitative endovascular balloon occlusion of the aorta

Moore

Rasmussen

2022

J Trauma Acute Care Surg

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A s with its original description in 1954, the modern development of resuscitative endovascular balloon occlusion of the aorta (REBOA) emerged from the crucible of war. 1 Early in the Afghanistan and Iraq Wars, data from the military's Joint Trauma System and registry showed that 25% of wounded service members died from potentially survivable injuries, 90% of those from uncontrolled bleeding before reaching surgical care. [2][3][4][5] Although the military had established the most comprehensive casualty care system in history, it was not working for service members with noncompressible torso hemorrhage and shock who required rapid intervention to support blood pressure and bleeding control before the operating room. Despite advances in blood component-based resuscitation, the otherwise surgery-centric paradigm of "get the patient into the operating room as soon as possible" needed reappraisal and new approaches.

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A Western Trauma Association critical decisions algorithm: Resuscitative endovascular balloon occlusion of the aorta

Abstract: A Western Trauma Association Critical Decisions Algorithm: REBOA, providing a practical approach to the use of REBOA in trauma, based on the existing scientific evidence, expert opinion and the input of the Western Trauma Association membership. @WesternTrauma #REBOA

Cited by 7 publications

References 49 publications

Systematic review to evaluate algorithms for REBOA use in trauma and identify a consensus for patient selection

Systematic review to evaluate algorithms for REBOA use in trauma and identify a consensus for patient selection

Vascular access complications associated with resuscitative endovascular balloon occlusion of the aorta in adult trauma patients: A systematic review and meta-analysis

A contemporary assessment of resuscitative endovascular balloon occlusion of the aorta

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