Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture

Asmar, Samer; Bible, Letitia; Chehab, Mohamad; Tang, Andrew; Khurrum, Muhammad; Douglas, Molly; Castañón, Lourdes; Kulvatunyou, Narong; Joseph, Bellal

doi:10.1016/j.jamcollsurg.2020.08.763

Cited by 28 publications

(35 citation statements)

References 35 publications

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“…Placement of REBOA in zone 3 for pelvic bleeding can be an effective approach to obtain temporary control if the operator is comfortable with the modality [5] , [6] , [7] . Porcine studies suggest that the ischemic burden and reperfusion related instability is lessened by occlusion of Zone 3 of the aorta when compared to Zone 1 [8] .…”

Section: Discussionmentioning

confidence: 99%

When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

Snyder

Schuerer

Bochicchio

et al. 2022

Trauma Case Reports

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Section: Discussionmentioning

confidence: 99%

When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

Snyder

Schuerer

Bochicchio

et al. 2022

Trauma Case Reports

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“…After reviewing the full text, 15 studies met the inclusion criteria in the meta-analysis [3,5,[21][22][23][24][25][26][27][28][29][30][31][32][33]. All studies had a low risk of bias for selective blinding.…”

Section: Systematic Literature Searchmentioning

confidence: 99%

“…Transfusion is an imperative method to resuscitate patients and is an indispensable step within peri-operation. There were 10 studies comparing preoperative transfusion between PP and AE [3,21,22,[24][25][26][27][28][29][30] and two studies on PP and REBOA [31,32] , which showed much more transfusion in PP group than in EI group (MD=2.53, 95% CI [0.01, 5.06], Fig. 3).…”

Section: Basic Characteristics Of Included Patientsmentioning

confidence: 99%

Pelvic packing or endovascular interventions: which should be given priority in managing hemodynamically unstable pelvic fractures? A systematic review and a meta-analysis

Zhang

et al. 2022

Preprint

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Background: Pelvic fractures in trauma patients can be associated with substantial massive hemorrhage. Mainly hemostasis interventions consist of pelvic packing (PP) and endovascular intervention (EI), such as angiography-embolization (AE) and resuscitative endovascular balloon occlusion of the aorta (REBOA). Whether PP or EI should be given priority for the management of hemodynamic unstable patients with pelvic fractures is still under debate. This meta-analysis aims to find out the evidence-based recommendations to fill the gap in literature. Materials and Methods: PubMed, CENTRAL, and EMBASE was searched for articles published from Jan 1st, 2000 to Jan 31st, 2022. Eligible studies, such as retrospective cohort study, propensity score matching studies, prospective cohort study, observational cohort study, quasi-randomized clinical trial evaluating PP and EI (AE or REBOA) managing patients with hemodynamically unstable pelvic fractures, were included. Mean Difference (MD), relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of included trials. This meta-analysis was performed to compare the effectiveness of the two methods in terms of mortality, unstable fracture pattens, Injury Severity Score (ISS), systolic blood pressure (SBP), lactate (LA), base deficiency (-BE), hemoglobin preoperatively, blood transfusion requirement, the time to and of operation, the complications.Results: 15 trials enrolling 1,136 patients were analyzed with the total mortality of 28.4% (323/1136). In our study, there was no effect of PP preference on the ISS (PP 36.4±10.4 vs. EI 34.5±12.7,), SBP (PP 81.1± 24.3 mmHg vs. EI 94.2±32.4 mmHg), LA (PP 4.66±2.72 mmol/L vs. 4.85±3.45 mmol/L), BE (PP 8.14±5.64 mmol/L vs. 6.66±5.68 mmol/L), unstable fracture pattens (RR=1.10, 95% CI [0.63, 1.92]). The application of PP was associated with lower preoperative hemoglobin level(PP 8.11±2.28 g/dl vs. EI 8.43±2.43 g/dl, p<0.05), more preoperative transfusion(MD=2.53, 95% CI [0.01, 5.06]), less postoperative transfusion within first 24 hours(MD=-1.09, 95% CI [-1.96, -0.22]), shorter waiting time to intervention(MD=-0.93, 95% CI [-1.54, -0.31]), shorter operation time of intervention(MD=-0.41, 95% CI [-0.52, -0.30]). PP has lower mortality rate due to uncontrolled hemorrhage in the acute phase (RR= 0.41, 95% CI [0.22, 0.79]). There is neither difference on mortality due to other complications (RR=1.60, 95% CI [0.79, 3.24]), nor total mortality (RR=0.92, 95%CI [0.49, 1.74]) (p>0.05).Conclusions: We firstly reached a conclusion that PP, a reliable hemostatic method, had advantages of reducing the amount of postoperative transfusion, shortening the time of waiting and operating and decreasing the mortality due to uncontrolled hemorrhage in the acute phase, without raising the odds of mortality due to complications. PP should be given a high priority in resuscitating the most pelvic fractures with hemodynamically unstable, especially in case of bleeding from veins and fracture sites, as well as inadequate EI. Sometimes AE should be regarded as a complementary treatment in case of the relative stable branch artery injury, the recurrent hypotension and ongoing hypotension after PP. REBOA is recommended in temporally transporting the hemorrhagic shock patients and stopping fatal bleeding from the main artery or multiple-sources.

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“…In the most recent published study, Asmar et al [22] also compared these two techniques in the management of hemodynamically unstable patients with pelvic fractures. This study included 156 patients, of which 52 were treated with PPP, 52 with REBOA, and another group of 52 with both PPP and REBOA.…”

Section: Journal Of Endovascularmentioning

confidence: 99%

REBOA or Preperitoneal Packing in Patients with Pelvic Fractures: Why Not Both?

Paran

Kessel

Hashavia

2021

JEVTM

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Resuscitative Endovascular Balloon Occlusion of the Aorta vs Pre-Peritoneal Packing in Patients with Pelvic Fracture

Cited by 28 publications

References 35 publications

When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

When REBOA grows wings: Resuscitative endovascular balloon occlusion of the aorta to facilitate aeromedical transport

Pelvic packing or endovascular interventions: which should be given priority in managing hemodynamically unstable pelvic fractures? A systematic review and a meta-analysis

REBOA or Preperitoneal Packing in Patients with Pelvic Fractures: Why Not Both?

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