Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Theodorou, Christina M.; Salcedo, Edgardo S.; DuBose, Joseph J.; Galante, Joseph M.

doi:10.26676/jevtm.v4i1.106

Cited by 14 publications

(24 citation statements)

References 33 publications

(36 reference statements)

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“…The use of REBOA should take into account skills, high expertise on their applicability [ 47 , 48 ], acceptability of clinicians and cost [ 49 , 50 ]. For optimal success, REBOA requires careful system-wide multidisciplinary implementation [ 51 ].…”

Section: Limitationsmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis

et al. 2021

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Background Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and uncontrolled haemorrhagic shock were recently published. To date, the clinical evidence of the efficacy of REBOA is still debated. We aimed to conduct a systematic review assessing the clinical efficacy and safety of REBOA in patients with major trauma and uncontrolled haemorrhagic shock. Methods We systematically searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2020. All randomized controlled trials and observational studies that investigated the use of REBOA compared to resuscitative thoracotomy (RT) with/without REBOA or no-REBOA were eligible. We followed the PRISMA and MOOSE guidelines. Two authors independently extracted data and appraised the risk of bias of included studies. Effect sizes were pooled in a meta-analysis using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Primary outcomes were mortality, volume of infused blood components, health-related quality of life, time to haemorrhage control and any adverse effects. Secondary outcomes were improvement in haemodynamic status and failure/success of REBOA technique. Results We included 11 studies (5866 participants) ranging from fair to good quality. REBOA was associated with lower mortality when compared to RT (aOR 0.38; 95% CI 0.20–0.74), whereas no difference was observed when REBOA was compared to no-REBOA (aOR 1.40; 95% CI 0.79–2.46). No significant difference in health-related quality of life between REBOA and RT (p = 0.766). The most commonly reported complications were amputation, haematoma and pseudoaneurysm. Sparse data and heterogeneity of reporting for all other outcomes prevented any estimate. Conclusions Our findings on overall mortality suggest a positive effect of REBOA among non-compressible torso injuries when compared to RT but no differences compared to no-REBOA. Variability in indications and patient characteristics prevents any conclusion deserving further investigation. REBOA should be promoted in specific training programs in an experimental setting in order to test its effectiveness and a randomized trial should be planned.

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Section: Limitationsmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis

et al. 2021

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“…REBOA use in trauma patients and others is a welldescribed technique to assist in managing, and in some cases preventing, potential catastrophic bleeding [6,7]. As indications for the use of REBOA in the management of life-threatening haemorrhage grow and its popularity amongst clinicians increases, more complications can be expected.…”

Section: Discussionmentioning

confidence: 99%

Extra Anatomical Bypass for Common Femoral Artery Pseudoaneurysm following Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

Krüger

Couch

Oosthuizen

2021

JEVTM

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Background: Improvements in the instrumentation and guidelines for the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has increased the use of it as an adjunct in managing haemorrhagic shock. REBOA-related complications continue to be assessed and described. Methods: We describe a case of a femoral artery pseudoaneurysm within an infected groin wound after REBOA usage in a 25-year-old male after several bouts of sepsis and complications related to the initial penetrating injury and associated ICU stay. Results: An extra-anatomical external iliac-to-superficial femoral artery bypass was performed using a 6mm polytetrafluoroethylene graft to treat the FAP successfully. Conclusion: REBOA is a well described adjunct in the management of haemorrhagic shock. The immediate and delayed complications should be not overlooked. Deviations from the expected postoperative course should be promptly recognised and managed by a clinician with appropriate expertise.

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“…When compared to a thoracotomy, Romagnoli et al 3 found in REBOA patients it took >2 additional minutes to occlude the aorta, a delay that could be crucial in a crashing patient. In a retrospective review of data from a level 1 trauma center, Theodorou et al 4 found that ∼44% of REBOA patients developed significant post‐procedural complications.…”

Section: Could We?mentioning

confidence: 99%