Ramiro Manzano-Nunez1, Claudia P Orlas, Juan P Herrera-Escobar, Samuel Galvagno, Joseph DuBose, Juan J Melendez, Jose J Serna, Alexander Salcedo, Camilo A Peña, Edison Angamarca, Tal Horer, Camilo J Salazar, Valeria Lopez-Castilla, Juan Ruiz-Yucuma, Fernando Rodriguez, Michael W Parra, Carlos A Ordoñez. 1. From the Clinical Research Center (R.M-N., C.P.O.), Fundacion Valle del Lili, Cali, Colombia; Department of Surgery (R.M-N., C.P.O., C.A.O.), Division of Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia; Department of Surgery (J.P.H-E.), Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts; R Adams Cowley Shock Trauma Center (S.G., J.D.), Baltimore, Maryland; Trauma and Acute Care Surgery Fellowship, Department of Surgery (J.J.M., J.J.S., A.S., C.A.P., E.A., C.A.O.), Universidad del Valle, Cali, Colombia; Orebro University (T.H.), Orebro, Sweden; School of Medicine (C.J.S., V.L-C., J.R-Y.), ICESI University, Cali, Colombia; and Department of Trauma Critical Care (M.W.P.), Broward General Level I Trauma Center, Fort Lauderdale, Florida.
Abstract
BACKGROUND: Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult trauma patients. METHODS: We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult trauma patients who underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed. RESULTS: We identified 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients, respectively. Overall, complications related to groin access occurred in 5.6% of patients (n = 24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis that used the logit transformation showed a 5% (95% CI 3%-9%) incidence of complications without significant heterogeneity (LR test: χ = 0.73, p = 0.2, Tau-square = 0.2). In a second meta-analysis, we used the Freeman-Tukey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%-7%) with low heterogeneity (I = 16.3%). CONCLUSION: We found that the incidence of complications related to groin access was of 4-5% based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.
BACKGROUND: Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult traumapatients. METHODS: We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult traumapatients who underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed. RESULTS: We identified 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients, respectively. Overall, complications related to groin access occurred in 5.6% of patients (n = 24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis that used the logit transformation showed a 5% (95% CI 3%-9%) incidence of complications without significant heterogeneity (LR test: χ = 0.73, p = 0.2, Tau-square = 0.2). In a second meta-analysis, we used the Freeman-Tukey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%-7%) with low heterogeneity (I = 16.3%). CONCLUSION: We found that the incidence of complications related to groin access was of 4-5% based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III.
Authors: Ramiro Manzano-Nunez; Julian Chica; Alexandra Gómez; Maria P Naranjo; Harold Chaves; Luis E Muñoz; Javier E Rengifo; Isabella Caicedo-Holguin; Juan C Puyana; Alberto F García Journal: Eur J Trauma Emerg Surg Date: 2020-06-28 Impact factor: 3.693
Authors: Muhammad Naeem; Mark J Hoegger; Frank W Petraglia; David H Ballard; Maria Zulfiqar; Michael N Patlas; Constantine Raptis; Vincent M Mellnick Journal: Radiographics Date: 2021-05-21 Impact factor: 6.312
Authors: Omar Bekdache; Tiffany Paradis; Yu Bai He Shen; Aly Elbahrawy; Jeremy Grushka; Dan Deckelbaum; Kosar Khwaja; Paola Fata; Tarek Razek; Andrew Beckett Journal: Trauma Surg Acute Care Open Date: 2019-04-15
Authors: Orkun Özkurtul; Holger Staab; Georg Osterhoff; Benjamin Ondruschka; Andreas Höch; Christoph Josten; Johannes Karl Maria Fakler Journal: Patient Saf Surg Date: 2019-06-24
Authors: Eileen M Bulger; Debra G Perina; Zaffer Qasim; Brian Beldowicz; Megan Brenner; Frances Guyette; Dennis Rowe; Christopher Scott Kang; Jennifer Gurney; Joseph DuBose; Bellal Joseph; Regan Lyon; Krista Kaups; Vidor E Friedman; Brian Eastridge; Ronald Stewart Journal: Trauma Surg Acute Care Open Date: 2019-09-20