Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature
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REVIEW
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Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature Emiliano Gamberini1* , Federico Coccolini2, Beatrice Tamagnini3, Costanza Martino1, Vittorio Albarello1, Marco Benni1, Marcello Bisulli4, Nicola Fabbri5, Tal Martin Hörer6, Luca Ansaloni2, Carlo Coniglio7, Marco Barozzi8 and Vanni Agnoletti1
Abstract Aims: Resuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results. Methods: The literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation. Results: Sixty-one articles met the inclusion criteria and were selected for the systematic review. Overall, they included 1355 treated with aortic endovascular balloon occlusion, and 883 (65%) patients died after the procedure. In most of the included cases, a shock state seemed to be present before the procedure. Time of death and inflation site was not described in the majority of included studies. Procedure-related and shock-related complications are described. Introducer sheath size and comorbidity seems to play the role of risk factors. Conclusions: Resuscitative endovascular balloon occlusion of the aorta is increasingly used in trauma victim resuscitation all over the world, to elevate blood pressure and limit fluid infusion, while other procedures aimed to stop the bleeding are performed. High mortality rate is probably due to the severity of the injuries. Time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very heterogeneous. Keywords: REBOA, Aortic balloon occlusion, Hemorrhagic shock, Severe trauma, Trauma system, Trauma center, Bleeding, Systematic review
Background Hemorrhagic shock is a major cause of death [1, 2]. Although the main aims of resuscitation are to stop the hemorrhage and restore circulating blood volume, persistent hemorrhage can be rapidly fatal. In major trauma, uncontrolled bleeding is the first cause of potentially preventable death [3–5]. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in a variety of clinical settings (postpartum hemorrhage, upper gastrointestinal hemorrhage, pelvic hemorrhage during pelvic/sacral tumor surgery, traumatic abdomino* Correspondence: [email protected] 1 Anesthesia and Intensive Care Department, AUSL Romagna Trauma Center “Maurizio Bufalini” Hospital, Viale Ghirotti 286, 47521 Cesena, Italy Full list of author information is available at the end of the article
pelvic hemorrhage, ruptured aneurysm abdominal aorta [6–9]) to successfully elevate central blood pressure in the setting of shock, even if the evidence base is weak and devoid of clear indications. The effectiveness in this clinical target seems to have been confirme
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