Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score‐adjusted untreated patients

Abstract

Epidemiologic study, level III; therapeutic study, level IV.

Resuscitative endovascular balloon occlusion of the aorta (REBOA): What have we learned?

“…Morphometric studies have proven the association of external corporal measurements, and other parameters, with the depth of insertion needed to deploy the balloon at the target site (32,33) This supports the feasibility of an accurate deploy of the balloon by the only means of physical exam. Most studies do not to use any imaging (16,18,20,31,34) and as such does not require either a vascular surgeon or interventional radiologist.…”

“…Survival rates of trauma patients undergoing REBOA from available studies (USA, Japan and Europe) range from 13% to 67% (14)(15)(16)18,20,27,(29)(30)(31)(32)(33)(34). Unfortunately, there are huge discrepancies in methodology, inclusion criteria and interventions.…”

“…Additionally, the dramatic improvement of hemodynamics may bring about a false sense of security that sets back decision-making and leads to unnecessary further examinations. Several authors have raised concerns about safety of REBOA (32,33), showing an increased mortality with the use of this tool. Maybe the poor prognosis that they found is the product of a non-ideal scenario.…”

Partial Zone II Resuscitative Endovascular Balloon Occlusion of the Aorta in Management of Multiple Trauma with Combined Abdominal and Pelvic Injury

“…The effectiveness in this clinical target seems to be confirmed by recent pooled analysis [10], that demonstrated an increase in mean systolic pressure by following REBOA use, but benefits in terms of overall reduction of mortality in trauma patients is controversial [11,12] (Table 1).…”

The future of resuscitative endovascular balloon occlusion in combat operations

“…In the Japanese system, emergency physicians can be credentialed after performing REBOA three times during residency training 16. A REBOA patient may have their device placed by an emergency medicine physician and definitive treatment provided by interventional radiology without direct involvement of a surgeon 17.…”