The end of balloons? Our take on the UK-REBOA trial

Abstract

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used. The recently published UK-REBOA trial aimed to investigate patients suffering haemorrhagic shock and randomized to standard care alone or REBOA as adjunct to standard care and concludes that REBOA may increase the mortality. Main body In this commentary we try to balance the discussion on use of REBOA and address limitations in the UK-REBOA trial that may have influenced the outcome of the study. Conclusion The situation is complex, and the patients are in extremis. In summary, we do not think this is the end of balloons.

Consensus on resuscitative endovascular balloon occlusion of the aorta in civilian (prehospital) trauma care: A Delphi study

“…This study seems to show a negative impact of REBOA incorporation in emergency room trauma care, but disregards the facts that the majority of patients in the REBOA-arm did not receive REBOA, pre-REBOA and procedure times were long and frequency of institutional REBOA deployments was low. 52,53 With the study methodology likely influencing the results, the possible benefit of earlier deployment to prevent deterioration and losing precious time has not been addressed and results must be cautiously interpreted.…”

Nomogram for predicting in-hospital mortality in trauma patients undergoing resuscitative endovascular balloon occlusion of the aorta: a retrospective multicenter study

“…Nonetheless, the utility of REBOA, including a new generation for partial REBOA, has been disseminated and regarded as a promising procedure for patients with exsanguination 23 . The first sole randomized controlled trial in the UK also has several limitations 24 . More relevant indications are warranted for the safe application of the REBOA procedure.…”

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) im prähospitalen Einsatz – Präsentation zweier Fälle

“…Fehlende andauernde Schulung und Expertise mögen ein Grund für die ernüchternden Ergebnisse des UK-REBOA Trial sein, in dem bei Patienten die zur Standardtherapie zusätzlich REBOA erhalten haben, eine höhere Mortalität nachzuweisen war [33]. Auch wenn der Trial deutliche Einschränkungen und diskussionswürdige Punkte aufweist, wie sie im begleitenden Editorial oder in Fachzeitschriften diskutiert wurden, ist es aktuell die einzige randomisierte kontrollierte Studie, und zukünftige Untersuchungen müssen zeigen, ob Evidenz wirklich für oder gegen REBOA spricht [34,35].…”