Article type
Abstract
"Background: Traumatic critical haemorrhage is the main cause of avoidable death after trauma, accounting for 50% of deaths in the first 24 hours. REBOA (Resuscitative Endovascular Balloon Occlusion Aorta) is placed by insertion into the femoral artery. Once REBOA is inflated, an arterial blockage is created to prevent bleeding and maintain blood supply to the brain, heart and lungs for as long as necessary to receive proper care
Objective: To assess the safety and effectiveness of REBOA technique in patients with abdomino-pelvic haemorrhage. Secondary objective was to incorporate the clinical experts' point of view in the assessment report, aimed at the potential REBOA implementation into routine clinical practice.
Methods: A systematic review of the available scientific literature about effectiveness and safety of REBOA in patients with traumatic abdomino-pelvic haemorrhage was carried out. A collaboration with clinical experts was carried out to incorporate an algorithm for the application of REBOA in the evidence synthesis.
Results: 24-hour mortality didn’t show statistically significant differences in the comparison of REBOA versus other interventions. However, in the comparison with the resuscitative thoracotomy (RT) subgroup, there was a superiority of REBOA over RT (OR= 0.26; 95%CI: 0.20 - 0.34; p<0.001). Regarding in-hospital mortality, overall results were obtained with statistically significant differences in the comparison of REBOA against the other interventions (OR= 0.90; 95%CI: 0.81 - 0.99; p=0.04). REBOA has shown a higher rate of lower limb amputation than its comparators (OR= 7.19; 95%CI: 2.00 - 25.89; p=0.003), as well as a higher risk of acute kidney injury with OR= 2.73 (95%CI: 1.74 - 4.30; p<0.001).
Conclusions: REBOA is effective in reducing 24-hour mortality when compared to RT. Overall, REBOA reduces in-hospital mortality compared to any comparator, particularly in the comparison with RT. REBOA is less safe than its comparators in terms of lower limb amputation, acute kidney damage, paraplegia and acute lung damage. The incorporated algorithm described in detail the inclusion and exclusion criteria for patients susceptible to REBOA and the steps to be followed for its application. Clinicians also stressed the importance of training professionals to reduce the adverse effects of the technique.
"
Objective: To assess the safety and effectiveness of REBOA technique in patients with abdomino-pelvic haemorrhage. Secondary objective was to incorporate the clinical experts' point of view in the assessment report, aimed at the potential REBOA implementation into routine clinical practice.
Methods: A systematic review of the available scientific literature about effectiveness and safety of REBOA in patients with traumatic abdomino-pelvic haemorrhage was carried out. A collaboration with clinical experts was carried out to incorporate an algorithm for the application of REBOA in the evidence synthesis.
Results: 24-hour mortality didn’t show statistically significant differences in the comparison of REBOA versus other interventions. However, in the comparison with the resuscitative thoracotomy (RT) subgroup, there was a superiority of REBOA over RT (OR= 0.26; 95%CI: 0.20 - 0.34; p<0.001). Regarding in-hospital mortality, overall results were obtained with statistically significant differences in the comparison of REBOA against the other interventions (OR= 0.90; 95%CI: 0.81 - 0.99; p=0.04). REBOA has shown a higher rate of lower limb amputation than its comparators (OR= 7.19; 95%CI: 2.00 - 25.89; p=0.003), as well as a higher risk of acute kidney injury with OR= 2.73 (95%CI: 1.74 - 4.30; p<0.001).
Conclusions: REBOA is effective in reducing 24-hour mortality when compared to RT. Overall, REBOA reduces in-hospital mortality compared to any comparator, particularly in the comparison with RT. REBOA is less safe than its comparators in terms of lower limb amputation, acute kidney damage, paraplegia and acute lung damage. The incorporated algorithm described in detail the inclusion and exclusion criteria for patients susceptible to REBOA and the steps to be followed for its application. Clinicians also stressed the importance of training professionals to reduce the adverse effects of the technique.
"