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

Jonathan James Morrison*, Richard E. Galgon, Jan Olaf Jansen, Jeremy W. Cannon, Todd Erik Rasmussen, Jonathan L. Eliason

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

234 Scopus citations

Abstract

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 infjects, 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.

Original languageEnglish
Pages (from-to)324-334
Number of pages11
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number2
DOIs
StatePublished - 1 Feb 2016
Externally publishedYes

Keywords

  • REBOA
  • Resuscitative endovascular balloon occlusion of the aorta
  • hemorrhage control
  • resuscitation
  • trauma surgery

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