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

Abstract

BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining popularity in the treatment of traumatic non-compressible torso bleeding. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic.MethodsCritical search from MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS were conducted from the earliest available dates until March 2018. Evidence-based articles, as well as gray literature at large, were analyzed regardless of the quality of articles.ResultsWe identified 1176 articles related to the topic from all available database sources and 57 reviews from the gray literature search. The final review yielded 105 articles. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center.ConclusionGrowing levels of evidence support the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment, and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use, and possible advantage of the prehospital and partial REBOA are topics for further research.Level of evidenceLevel III.

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study

“…This may have resulted from a bias that may have occurred during collection of data or due to the small amount of data (total number of patients was 54). In other studies, there is no evidence that males have a higher risk of occurrence of complications [13,15,17]. The judgment of this phenomenon should be withheld until more data is accumulated.…”

“…Two of them had multiple organ (spleen, liver, and lung) injuries, and the other had solitary lung injury. REBOA is indicated mostly in patients with life-threatening hemorrhagic injuries below the diaphragm [12], and the performance of REBOA in thoracic trauma patients with or without other torso injuries has been debated [13]. Ordoñez et al [14] suggested that the combination of RE-BOA and ERT could be useful in patients with non-compressible torso hemorrhage secondary to penetrating chest trauma in their 7-case series report.…”

Pitfalls, Complications, and Necessity of Education about REBOA: A Single Regional Trauma Center Study

“…Ordoñez et al [18], in their seven-case series report, suggested that the combination of REBOA and emergent resuscitative thoracotomy could be useful in pa-tients with non-compressible torso hemorrhage secondary to penetrating chest trauma. However, we performed REBOA only in patients with an injury below the diaphragm because REBOA is usually indicated in patients with injuries below the diaphragm [19], and performing REBOA in thoracic trauma patients with or without other torso injuries is debated [11]. Failure of the procedure was defined as when the RE-BOA balloon was not located in the desired target Zone during the first procedure.…”

“…REBOA involves temporary placement of a balloon in the aorta to block the proximal portion of the bleeding site [3,[11][12][13]. REBOA is less invasive compared to OACC and may provide similar physiological results [14].…”

“…REBOA is less invasive compared to OACC and may provide similar physiological results [14]. Despite these benefits, REBOA is not widely used, due to lack of understanding of the procedure, lack of skills, and potential complications associated with the procedure [3,11,12]. Some of the known complications of REBOA include aortic occlusion, postoperative thrombosis, and limb amputation [15].…”