A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients

Abstract

BackgroundThe objective of this systematic review and meta-analysis was to determine the effect of REBOA, compared to resuscitative thoracotomy, on mortality and among non-compressible torso hemorrhage trauma patients.MethodsRelevant articles were identified by a literature search in MEDLINE and EMBASE. We included studies involving trauma patients suffering non-compressible torso hemorrhage. Studies were eligible if they evaluated REBOA and compared it to resuscitative thoracotomy. Two investigators independently assessed articles for inclusion and exclusion criteria and selected studies for final analysis. We conducted meta-analysis using random effect models.ResultsWe included three studies in our systematic review. These studies included a total of 1276 patients. An initial analysis found that although lower in REBOA-treated patients, the odds of mortality did not differ between the compared groups (OR 0.42; 95% CI 0.17–1.03). Sensitivity analysis showed that the risk of mortality was significantly lower among patients who underwent REBOA, compared to those who underwent resuscitative thoracotomy (RT) (RR 0.81; 95% CI 0.68–0.97).ConclusionOur meta-analysis, mainly from observational data, suggests a positive effect of REBOA on mortality among non-compressible torso hemorrhage patients. However, these results deserve further investigation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13017-017-0142-5) contains supplementary material, which is available to authorized users.

How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

“…A recent meta-analysis13 did not show any advantage of REBOA over resuscitative thoracotomy. However, this may reflect that randomised studies in this field are technically and ethically difficult to achieve.…”

REBOA: Where are we now?

“…The military also describe impressive and successful case reports . A meta‐analysis of REBOA and another of REBOA and open aortic cross clamping together with an early REBOA registry report all suggested positive effects on outcomes and are broadly supportive. There followed a statement from the American College of Surgeons highlighting indications, guidelines and complications.…”

Feasibility study for implementation of resuscitative balloon occlusion of the aorta in peri‐arrest, exsanguinating trauma at an adult level 1 Australian trauma centre

“…There is controversy in the literature about the outcome effectiveness of REBOA for traumatic shock, with enthusiastic proponents counterbalanced by cautious sceptics . Clear evidence supporting its introduction is lacking, with much of the literature derived from animal studies, retrospective data and meta or propensity analyses . In a recent US national matched analysis, Joseph et al .…”

“…REBOA provides a means of temporary control in patients with severe non‐compressible haemorrhage – as a potential bridge to definitive haemorrhage control and therefore survival . However, the procedure requires specific technical expertise as well as integration into current models of trauma reception and resuscitation – and there are conflicting reports about whether REBOA contributes to survival . There are also significant reported complications associated with REBOA insertion …”