A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients

Manzano-Núñez, Ramiro; Orlas, Claudia; Herrera-Escobar, Juan P.; Galvagno, Samuel M.; DuBose, Joseph J.; Meléndez, Juan J.; Serna, José Julián; Salcedo, Alexander; Peña, Carlos Eduardo Cubillos; Angamarca, Edison; Hörer, Tal M.; Salazar, Camilo; López-Castilla, Valeria; Ruiz-Yucuma, Juan; Rodríguez, Fernando; Parra, Michael W.; Ordóñez, Carlos A.

doi:10.1097/ta.0000000000001978

Cited by 64 publications

(49 citation statements)

References 28 publications

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“…Our complication rate was significantly higher than that reported in other studies, with one systematic review of 414 patients reporting a 5% rate of access-related complications [21]. As we are reporting a very small case series of nine patients at the start of implementation of a REBOA program, it is not surprising that our complication rate is higher than that reported in large series in the literature.…”

Section: Discussioncontrasting

confidence: 68%

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Theodorou

Salcedo

DuBose

et al. 2020

JEVTM

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Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success.Methods:All REBOA placements from January 2016-February 2017 at a level 1 trauma center were reviewed for opportunities for improvement (OFI). From September 2016-February 2017 all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure.Results:REBOA was introduced at our institution in September 2015, with first placement in January 2016. Trauma surgery, Emergency Department, and Operating Room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. Conclusion:Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, systems factors must be addressed. Systems processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.

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Section: Discussioncontrasting

confidence: 68%

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Theodorou

Salcedo

DuBose

et al. 2020

JEVTM

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“…However, a recent review questioned the safety of the procedure, showing no evidence of improved survival 70. Other studies have shown the technique to be associated with an increased complication rate, notably lower limb amputations and acute kidney injuries when compared with a similar cohort of patients 23 77…”

Section: Discussionmentioning

confidence: 99%

“…There was an overall incidence of complications related to groin access equivalent to 4%–5%, including serious complications such as lower limb ischemia necessitating amputation in 2.1% of cases. Inserting the balloon catheter through the superficial femoral artery instead of the common femoral artery was a likely cause of such complications 77…”

Section: Discussionmentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

Bekdache¹,

Paradis

Shen

et al. 2019

Trauma Surg Acute Care Open

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BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining popularity in the treatment of traumatic non-compressible torso bleeding. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic. Advances in invasive radiology coupled with new damage control measures assisted in the refinement of the technique with promising outcomes. The literature continues to have substantial heterogeneity about REBOA indications, applications, and the challenges confronted when implementing the technique in a level I trauma center. Scoping reviews are excellent platforms to assess the diverse literature of a new technique. It is for the first time that a scoping review is adopted for this topic.MethodsCritical search from MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS were conducted from the earliest available dates until March 2018. Evidence-based articles, as well as gray literature at large, were analyzed regardless of the quality of articles.ResultsWe identified 1176 articles related to the topic from all available database sources and 57 reviews from the gray literature search. The final review yielded 105 articles. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center.ConclusionGrowing levels of evidence support the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment, and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use, and possible advantage of the prehospital and partial REBOA are topics for further research.Level of evidenceLevel III.

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“…While in LMICs, the insertion and deployment of REBOA occurred more frequently in the operating room and by surgical cutdown, in HICs, these procedures were performed more often in the emergency room and by blind percutaneous insertion. Previous studies have shown a higher incidence of groin access complications when REBOA is inserted by surgical cutdown [17], and some authors recommend in favor of performing groin access in an operating room controlled setting [18]. Therefore, our findings are of concern because a lack of standardization of surgical procedures for REBOA insertion and deployment can jeopardize clinical outcomes and patient safety.…”

Section: Discussionmentioning

confidence: 72%

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

Manzano-Núñez

McGreevy²,

Orlas

et al. 2020

World J Emerg Surg

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) could provide a survival benefit to severely injured patients as it may improve their initial ability to survive the hemorrhagic shock. Although the evidence supporting the use of REBOA is not conclusive, its use has expanded worldwide. We aim to compare the management approaches and clinical outcomes of trauma patients treated with REBOA according to the countries’ income based on the World Bank Country and Lending Groups. Methods We used data from the AORTA (USA) and the ABOTrauma (multinational) registries. Patients were stratified into two groups: (1) high-income countries (HICs) and (2) low-to-middle income countries (LMICs). Propensity score matching extracted 1:1 matched pairs of subjects who were from an LMIC or a HIC based on age, gender, the presence of pupillary response on admission, impeding hypotension (SBP ≤ 80), trauma mechanism, ISS, the necessity of CPR on arrival, the location of REBOA insertion (emergency room or operating room) and the amount of PRBCs transfused in the first 24 h. Logistic regression (LR) was used to examine the association of LMICs and mortality. Results A total of 817 trauma patients from 14 countries were included. Blind percutaneous approach and surgical cutdown were the preferred means of femoral cannulation in HICs and LIMCs, respectively. Patients from LMICs had a significantly higher occurrence of MODS and respiratory failure. LR showed no differences in mortality for LMICs when compared to HICs; neither in the non-matched cohort (OR = 0.63; 95% CI: 0.36‑1.09; p = 0.1) nor in the matched cohort (OR = 1.45; 95% CI: 0.63‑3,33; p = 0.3). Conclusion There is considerable variation in the management practices of REBOA and the outcomes associated with this intervention between HICs and LMICs. Although we found significant differences in multiorgan and respiratory failure rates, there were no differences in the risk-adjusted odds of mortality between the groups analyzed. Trauma surgeons practicing REBOA around the world should joint efforts to standardize the practice of this endovascular technology worldwide.

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A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients

Abstract: Systematic review and meta-analysis, level III.

Cited by 64 publications

References 28 publications

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course

Resuscitative endovascular balloon occlusion of the aorta (REBOA): indications: advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

Outcomes and management approaches of resuscitative endovascular balloon occlusion of the aorta based on the income of countries

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