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

World J Emerg Surg. 2017 Jul 14;12:30. doi: 10.1186/s13017-017-0142-5. eCollection 2017.

Abstract

Background: The 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.

Methods: Relevant 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.

Results: We 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).

Conclusion: Our 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.

Keywords: Endovascular procedures; Injuries; Non-compressible torso hemorrhage; REBOA; Resuscitation strategies; Traumatic shock.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Aorta / surgery*
  • Balloon Occlusion / methods*
  • Balloon Occlusion / standards
  • Balloon Occlusion / trends
  • Constriction
  • Endovascular Procedures / methods*
  • Endovascular Procedures / standards
  • Endovascular Procedures / trends
  • Humans
  • Resuscitation / methods
  • Resuscitation / mortality
  • Shock, Hemorrhagic / therapy
  • Survival Analysis
  • Thoracic Injuries / therapy