Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature

Abstract

AimsResuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results.MethodsThe literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation.ResultsSixty-one articles met the inclusion criteria and were selected for the systematic review. Overall, they included 1355 treated with aortic endovascular balloon occlusion, and 883 (65%) patients died after the procedure. In most of the included cases, a shock state seemed to be present before the procedure. Time of death and inflation site was not described in the majority of included studies. Procedure-related and shock-related complications are described. Introducer sheath size and comorbidity seems to play the role of risk factors.ConclusionsResuscitative endovascular balloon occlusion of the aorta is increasingly used in trauma victim resuscitation all over the world, to elevate blood pressure and limit fluid infusion, while other procedures aimed to stop the bleeding are performed. High mortality rate is probably due to the severity of the injuries. Time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very heterogeneous.

Effect of resuscitative endovascular balloon occlusion of the aorta in hemodynamically unstable patients with multiple severe torso trauma: a retrospective study

“…Its effectiveness for trauma patients has been evaluated in many large-scale studies [9–13]; however, the evidence base is weak and clear indications are lacking. Furthermore, although the time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very important, they are heterogeneous factors [11, 14–18]. In addition, while it has been conceivable that REBOA may be effective in patients with severe trauma when integrated with surgery or interventional radiology (IVR) without delay [9], it remains challenging to successfully perform REBOA in patients with severe multiple torso traumas.…”

Resuscitative endovascular balloon occlusion of the aorta may increase the bleeding of minor thoracic injury in severe multiple trauma patients: a case report

“…However, complications developing around the site proximal to the occlusion, such as the possibility of increase in bleeding in the site proximal to the occlusion and the side effects of hyperperfusion, have hardly been studied to date. A systematic review [2] of REBOA, which included 61 articles and 1355 patients, showed that complications of the site proximal to the occlusion occurred only in one patient (0.07%) [3]. …”

REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting

“…Introduced by a femoral artery sheath, an endovascular balloon is inflated in the aorta, occluding the vessel and acting as an endovascular clamp (Figure 2). REBOA has been demonstrated to be efficacious in a large human case series 12. A prospective registry of 114 patients with critical haemodynamic instability in the US armed forces confirmed that in-hospital REBOA might be a viable alternative to immediate resuscitative thoracotomy (RT) for achieving rapid proximal control.…”