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A systematic review and meta-analysis of the use of resuscitative endovascular balloon occlusion of the aorta in the management of major exsanguination
Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.
R. Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, USA.
Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
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2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Article, review/survey (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Circulatory collapse is a leading cause of mortality among traumatic major exsanguination and in ruptured aortic aneurysm patients. Approximately 40% of patients die before hemorrhage control is achieved. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive surgical or endovascular repair. A systematic review was conducted for the current clinical use of REBOA in patients with hemodynamic instability and to discuss its potential role in improving prehospital and in-hospital outcome.

METHODS: Systematic review and meta-analysis (1900-2017) using MEDLINE, Cochrane, EMBASE, Web of Science and Central and Emcare using the keywords "aortic balloon occlusion", "aortic balloon tamponade", "REBOA", and "Resuscitative Endovascular Balloon Occlusion" in combination with hemorrhage control, hemorrhage, resuscitation, shock, ruptured abdominal or thoracic aorta, endovascular repair, and open repair. Original published studies on human subjects were considered.

RESULTS: A total of 490 studies were identified; 89 met criteria for inclusion. Of the 1436 patients, overall reported mortality was 49.2% (613/1246) with significant differences (p < 0.001) between clinical indications. Hemodynamic shock was evident in 79.3%, values between clinical indications showed significant difference (p < 0.001). REBOA was favored as treatment in trauma patients in terms of mortality. Pooled analysis demonstrated an increase in mean systolic pressure by almost 50 mmHg following REBOA use.

CONCLUSION: REBOA has been used in trauma patients and ruptured aortic aneurysm patients with improvement of hemodynamic parameters and outcomes for several decades. Formal, prospective study is warranted to clarify the role of this adjunct in all hemodynamic unstable patients.

Place, publisher, year, edition, pages
Springer Medizin , 2018.
Keywords [en]
Aortic balloon occlusion, Endovascular, REBOA, Shock, Trauma
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-67105DOI: 10.1007/s00068-018-0959-yPubMedID: 29785654OAI: oai:DiVA.org:oru-67105DiVA, id: diva2:1211107
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-05-30Bibliographically approved

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Hörer, Tal M.

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