Resuscitative Endovascular Balloon Occlusion of Aorta: A Systematic Review

Kinslow, Kyle; Shepherd, Aaron; McKenney, Mark; Elkbuli, Adel

doi:10.1177/0003134820972985

Cited by 12 publications

(10 citation statements)

References 59 publications

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“…REBOA may also be used as an adjunct to PPP to stem temporary bleeding [ 224 , 225 ]. The available data suggest that REBOA can temporarily improve haemodynamics [ 226 , 227 ]. The evidence demonstrating that REBOA improves survival is conflicting [ 228 – 230 ] and REBOA is associated with potentially significant complications [ 224 , 230 ].…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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Background Severe trauma represents a major global public health burden and the management of post-traumatic bleeding continues to challenge healthcare systems around the world. Post-traumatic bleeding and associated traumatic coagulopathy remain leading causes of potentially preventable multiorgan failure and death if not diagnosed and managed in an appropriate and timely manner. This sixth edition of the European guideline on the management of major bleeding and coagulopathy following traumatic injury aims to advise clinicians who care for the bleeding trauma patient during the initial diagnostic and therapeutic phases of patient management. Methods The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma included representatives from six European professional societies and convened to assess and update the previous version of this guideline using a structured, evidence-based consensus approach. Structured literature searches covered the period since the last edition of the guideline, but considered evidence cited previously. The format of this edition has been adjusted to reflect the trend towards concise guideline documents that cite only the highest-quality studies and most relevant literature rather than attempting to provide a comprehensive literature review to accompany each recommendation. Results This guideline comprises 39 clinical practice recommendations that follow an approximate temporal path for management of the bleeding trauma patient, with recommendations grouped behind key decision points. While approximately one-third of patients who have experienced severe trauma arrive in hospital in a coagulopathic state, a systematic diagnostic and therapeutic approach has been shown to reduce the number of preventable deaths attributable to traumatic injury. Conclusion A multidisciplinary approach and adherence to evidence-based guidelines are pillars of best practice in the management of severely injured trauma patients. Further improvement in outcomes will be achieved by optimising and standardising trauma care in line with the available evidence across Europe and beyond.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

et al. 2023

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“…Full texts were retrieved and assessed by the same reviewers independently. We also screened the reference lists of publications and previous systematic reviews for additional records 5,8–12 . Disagreement was resolved after review by a third reviewer (N.A.…”

Section: Methodsmentioning

confidence: 99%

“…We also screened the reference lists of publications and previous systematic reviews for additional records. 5,[8][9][10][11][12] Disagreement was resolved after review by a third reviewer (N.A. and E.G.W.).…”

Section: Search Strategy and Study Selectionmentioning

confidence: 99%

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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“…Studies on REBOA have not consistently found a mortality benefit [6]. Mortality may not be the appropriate endpoint to assess this modality.…”

Section: Introductionmentioning

confidence: 98%

Prolonged Partial REBOA: A Practice Paradigm for Managing Hemorrhage from Abdominal Gunshot Wounds

Zebley¹,

Halpern²,

Matecki³

et al. 2023

JEVTM

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a valuable tool for management of life-threateningtruncal hemorrhage. However, prolonged use of REBOA is limited by the ischemia that it causes distalto the occlusion. Partial REBOA (pREBOA) is a developing technique to inflate the balloon partially to allow for avariable degree of distal blood flow and mitigate some of the complications of prolonged occlusion of the aortawhile also ameliorating ongoing blood loss. We describe a case of a patient who presented with a gunshot woundto the right upper quadrant of the abdomen with significant liver, kidney, and colon injuries. The patient was successfullytreated with pREBOA for 20 hours without ischemic sequalae. This is the longest reported use of prolongedpREBOA and suggests that this technique may offer a means for hemorrhage control in the pre-/intra- andpostoperative settings..

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Resuscitative Endovascular Balloon Occlusion of Aorta: A Systematic Review

Cited by 12 publications

References 59 publications

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition

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

Prolonged Partial REBOA: A Practice Paradigm for Managing Hemorrhage from Abdominal Gunshot Wounds

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