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A systematic review of the use of resuscitative endovascular balloon occlusion of the aorta in the management of hemorrhagic shock

Morrison, Jonathan James MD, PhD; Galgon, Richard E. MD, MS; Jansen, Jan Olaf FRCS, FFICM; Cannon, Jeremy W. MD, SM; Rasmussen, Todd Erik MD; Eliason, Jonathan L. MD

Journal of Trauma and Acute Care Surgery: February 2016 - Volume 80 - Issue 2 - p 324–334
doi: 10.1097/TA.0000000000000913
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BACKGROUND Torso hemorrhage remains a leading cause of potentially preventable death within trauma, acute care, vascular, and obstetric practice. A proportion of patients exsanguinate before hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive hemostasis. A systematic review was conducted to characterize the current clinical use of REBOA and its effect on hemodynamic profile and mortality.

METHODS A systematic review (1946–2015) was conducted using EMBASE and MEDLINE. Original studies on human subjects, published in English language journals, were considered. Articles were included if they reported data on hemodynamic profile and mortality.

RESULTS A total of 83 studies were identified; 41 met criteria for inclusion. Clinical settings included postpartum hemorrhage (5), upper gastrointestinal bleeding (3), pelvic surgery (8), trauma (15), and ruptured aortic aneurysm (10). Of the 857 patients, overall mortality was 423 (49.4%); shock was evident in 643 (75.0%). Pooled analysis demonstrated an increase in mean systolic pressure by 53 mm Hg (95% confidence interval, 44–61 mm Hg) following REBOA use. Data exhibited moderate heterogeneity with an I2 of 35.5.

CONCLUSION REBOA has been used in a variety of clinical settings to successfully elevate central blood pressure in the setting of shock. Overall, the evidence base is weak with no clear reduction in hemorrhage-related mortality demonstrated. Formal, prospective study is warranted to clarify the role of this adjunct in torso hemorrhage.

LEVEL OF EVIDENCE Systematic review, level IV.

From the Academic Unit of Surgery (J.J.M.), Glasgow Royal Infirmary, Glasgow; Academic Department of Military Surgery and Trauma (J.J.M.), Royal Centre for Defence Medicine, Birmingham; and Departments of Surgery and Intensive Care Medicine (J.O.J.), Aberdeen Royal Infirmary and Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom; Department of Anesthesiology (R.E.G.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and Division of Traumatology, Surgical Critical Care and Emergency Surgery (J.W.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; US Combat Casualty Care Research Program (T.E.R.), Fort Detrick, Frederick; The Norman M. Rich Department of Surgery (T.E.R.), The Uniformed Services University of the Health Sciences, Bethesda, Maryland; and The Section of Vascular Surgery (J.L.E.), University of Michigan, Ann Arbor, Michigan.

Submitted: July 12, 2015, Revised: October 3, 2015, Accepted: October 16, 2015, Published online: October 30, 2015.

The viewpoints expressed in this outline are those of the author and do not reflect the official position of the US Air Force, US Department of Defense, or the UK Ministry of Defence.

Address for reprints: Jonathan J. Morrison, MD, PhD, Department of Vascular Surgery, South Glasgow University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, United Kingdom; email: jjmorrison@outlook.com.

© 2016 Lippincott Williams & Wilkins, Inc.