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    Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis

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    Author
    Castellini, Greta
    Gianola, Silvia
    Biffi, Annalisa
    Porcu, Gloria
    Fabbri, Andrea
    Ruggieri, Maria Pia
    Coniglio, Carlo
    Napoletano, Antonello
    Coclite, Daniela
    D'Angelo, Daniela
    Fauci, Alice Josephine
    Iacorossi, Laura
    Latina, Roberto
    Salomone, Katia
    Gupta, Shailvi
    Iannone, Primiano
    Chiara, Osvaldo
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    Date
    2021-08-12
    Journal
    World Journal of Emergency Surgery : WJES
    Publisher
    Springer Nature
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1186/s13017-021-00386-9
    Abstract
    Background: Multiple studies regarding the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in patients with non-compressible torso injuries and uncontrolled haemorrhagic shock were recently published. To date, the clinical evidence of the efficacy of REBOA is still debated. We aimed to conduct a systematic review assessing the clinical efficacy and safety of REBOA in patients with major trauma and uncontrolled haemorrhagic shock. Methods: We systematically searched MEDLINE (PubMed), EMBASE and CENTRAL up to June 2020. All randomized controlled trials and observational studies that investigated the use of REBOA compared to resuscitative thoracotomy (RT) with/without REBOA or no-REBOA were eligible. We followed the PRISMA and MOOSE guidelines. Two authors independently extracted data and appraised the risk of bias of included studies. Effect sizes were pooled in a meta-analysis using random-effects models. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation methodology. Primary outcomes were mortality, volume of infused blood components, health-related quality of life, time to haemorrhage control and any adverse effects. Secondary outcomes were improvement in haemodynamic status and failure/success of REBOA technique. Results: We included 11 studies (5866 participants) ranging from fair to good quality. REBOA was associated with lower mortality when compared to RT (aOR 0.38; 95% CI 0.20-0.74), whereas no difference was observed when REBOA was compared to no-REBOA (aOR 1.40; 95% CI 0.79-2.46). No significant difference in health-related quality of life between REBOA and RT (p = 0.766). The most commonly reported complications were amputation, haematoma and pseudoaneurysm. Sparse data and heterogeneity of reporting for all other outcomes prevented any estimate. Conclusions: Our findings on overall mortality suggest a positive effect of REBOA among non-compressible torso injuries when compared to RT but no differences compared to no-REBOA. Variability in indications and patient characteristics prevents any conclusion deserving further investigation. REBOA should be promoted in specific training programs in an experimental setting in order to test its effectiveness and a randomized trial should be planned.
    Rights/Terms
    © 2021. The Author(s).
    Keyword
    Systematic review
    Resuscitative Endovascular Balloon Occlusion of the Aorta
    Major trauma haemorrhage
    Resuscitative thoracotomy
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16447
    ae974a485f413a2113503eed53cd6c53
    10.1186/s13017-021-00386-9
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