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dc.contributor.authorCastellini, Greta
dc.contributor.authorGianola, Silvia
dc.contributor.authorBiffi, Annalisa
dc.contributor.authorPorcu, Gloria
dc.contributor.authorFabbri, Andrea
dc.contributor.authorRuggieri, Maria Pia
dc.contributor.authorConiglio, Carlo
dc.contributor.authorNapoletano, Antonello
dc.contributor.authorCoclite, Daniela
dc.contributor.authorD'Angelo, Daniela
dc.contributor.authorFauci, Alice Josephine
dc.contributor.authorIacorossi, Laura
dc.contributor.authorLatina, Roberto
dc.contributor.authorSalomone, Katia
dc.contributor.authorGupta, Shailvi
dc.contributor.authorIannone, Primiano
dc.contributor.authorChiara, Osvaldo
dc.date.accessioned2021-08-23T18:17:23Z
dc.date.available2021-08-23T18:17:23Z
dc.date.issued2021-08-12
dc.identifier.urihttp://hdl.handle.net/10713/16447
dc.description.abstractBackground: 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.en_US
dc.description.urihttps://doi.org/10.1186/s13017-021-00386-9en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.relation.ispartofWorld Journal of Emergency Surgery : WJESen_US
dc.rights© 2021. The Author(s).en_US
dc.subjectSystematic reviewen_US
dc.subjectResuscitative Endovascular Balloon Occlusion of the Aortaen_US
dc.subjectMajor trauma haemorrhageen_US
dc.subjectResuscitative thoracotomyen_US
dc.titleResuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysisen_US
dc.typeArticleen_US
dc.identifier.doi10.1186/s13017-021-00386-9
dc.identifier.pmid34384452
dc.source.volume16
dc.source.issue1
dc.source.beginpage41
dc.source.endpage
dc.source.countryEngland


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