Stefano Granieri1, Simone Frassini2,3, Stefania Cimbanassi4, Alessandro Bonomi5,6, Sissi Paleino7,5, Laura Lomaglio7, Andrea Chierici7,5, Federica Bruno7, Raoul Biondi8, Salomone Di Saverio9, Mansoor Khan10, Christian Cotsoglou7. 1. General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. stefano.granieri@asst-brianza.it. 2. University of Pavia, Corso Str. Nuova, 65, 27100, Pavia, Italy. 3. General Surgery Unit, Department of Surgery, Fondazione I.R.C.C.S. Policlinico San Matteo, Viale Camillo Golgi, 19, 27100, Pavia, Italy. 4. Emergency and Trauma Surgery, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy. 5. University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy. 6. General Surgery Unit, ASST Fatebenefratelli-Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy. 7. General Surgery Unit, ASST Brianza, Vimercate Hospital, Via Santi Cosma e Damiano, 10, 20871, Vimercate, Italy. 8. Department of Cardiac Surgery, Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France. 9. Department of General Surgery, University of Insubria, ASST Sette Laghi, Viale Luigi Borri, 57, 21100, Varese, Italy. 10. Department of Surgery, Brighton and Sussex University Hospitals NHS Trust, Kemptown, Brighton, BN2 1DH, UK.
Abstract
PURPOSE: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a minimally invasive technique of aortic occlusion (AO). It has been demonstrated to be safe and effective with appropriate training in traumatic hemorrhage with hemodynamic instability; however, its indications are still debated. The aim of this systematic review and meta-analysis is to assess the impact of REBOA on mortality in torso trauma patient with severe non-compressible hemorrhage compared to other temporizing hemostatic techniques. STUDY DESIGN: The primary outcome is represented by 24-h, and in-hospital mortality. Secondary outcomes are post-procedural hemodynamic improvement (systolic blood pressure-SBP), mean injury severity score (ISS) differences, treatment-related morbidity, transfusional requirements and identification of prognostic factors. RESULTS: A significant survival benefit at 24 h (RR 0.46; 95% CI 0.27-0.79; I2: 55%; p = 0.005) was highlighted in patients undergoing REBOA. Regarding in-hospital mortality (RR 0.99; 95% CI 0.75-1.32; I2: 73%; p = 0.98) no differences in risk of death were noticed. A hemodynamic improvement-although not significant-was highlighted, with 55.8 mmHg post-AO SBP mean difference between REBOA and control groups. A significantly lower mean number of packed Red Blood Cells (pRBCs) was noticed for REBOA patients (mean difference: - 3.02; 95% CI - 5.79 to - 0.25; p = 0.033). Nevertheless, an increased risk of post-procedural complications (RR 1.66; 95% CI 0.39-7.14; p = 0.496) was noticed in the REBOA group. CONCLUSIONS: REBOA may represent a valid tool in the initial treatment of multiple sites subdiaphragmatic hemorrhage with refractory hemodynamic instability. However, due to several important limitations of the present study, our findings should be interpreted with caution. LEVEL OF EVIDENCE: Level III according to ELIS (SR/MA with up to two negative criteria).
PURPOSE: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) represents a minimally invasive technique of aortic occlusion (AO). It has been demonstrated to be safe and effective with appropriate training in traumatic hemorrhage with hemodynamic instability; however, its indications are still debated. The aim of this systematic review and meta-analysis is to assess the impact of REBOA on mortality in torso trauma patient with severe non-compressible hemorrhage compared to other temporizing hemostatic techniques. STUDY DESIGN: The primary outcome is represented by 24-h, and in-hospital mortality. Secondary outcomes are post-procedural hemodynamic improvement (systolic blood pressure-SBP), mean injury severity score (ISS) differences, treatment-related morbidity, transfusional requirements and identification of prognostic factors. RESULTS: A significant survival benefit at 24 h (RR 0.46; 95% CI 0.27-0.79; I2: 55%; p = 0.005) was highlighted in patients undergoing REBOA. Regarding in-hospital mortality (RR 0.99; 95% CI 0.75-1.32; I2: 73%; p = 0.98) no differences in risk of death were noticed. A hemodynamic improvement-although not significant-was highlighted, with 55.8 mmHg post-AO SBP mean difference between REBOA and control groups. A significantly lower mean number of packed Red Blood Cells (pRBCs) was noticed for REBOA patients (mean difference: - 3.02; 95% CI - 5.79 to - 0.25; p = 0.033). Nevertheless, an increased risk of post-procedural complications (RR 1.66; 95% CI 0.39-7.14; p = 0.496) was noticed in the REBOA group. CONCLUSIONS: REBOA may represent a valid tool in the initial treatment of multiple sites subdiaphragmatic hemorrhage with refractory hemodynamic instability. However, due to several important limitations of the present study, our findings should be interpreted with caution. LEVEL OF EVIDENCE: Level III according to ELIS (SR/MA with up to two negative criteria).
Authors: Massimo Sartelli; Francesco M Labricciosa; Pamela Barbadoro; Leonardo Pagani; Luca Ansaloni; Adrian J Brink; Jean Carlet; Ashish Khanna; Alain Chichom-Mefire; Federico Coccolini; Salomone Di Saverio; Addison K May; Pierluigi Viale; Richard R Watkins; Luigia Scudeller; Lilian M Abbo; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Sara Al-Dahir; Majdi N Al-Hasan; Halil Alis; Carlos Alves; André R Araujo da Silva; Goran Augustin; Miklosh Bala; Philip S Barie; Marcelo A Beltrán; Aneel Bhangu; Belefquih Bouchra; Stephen M Brecher; Miguel A Caínzos; Adrian Camacho-Ortiz; Marco Catani; Sujith J Chandy; Asri Che Jusoh; Jill R Cherry-Bukowiec; Osvaldo Chiara; Elif Colak; Oliver A Cornely; Yunfeng Cui; Zaza Demetrashvili; Belinda De Simone; Jan J De Waele; Sameer Dhingra; Francesco Di Marzo; Agron Dogjani; Gereltuya Dorj; Laurent Dortet; Therese M Duane; Mutasim M Elmangory; Mushira A Enani; Paula Ferrada; J Esteban Foianini; Mahir Gachabayov; Chinmay Gandhi; Wagih Mommtaz Ghnnam; Helen Giamarellou; Georgios Gkiokas; Harumi Gomi; Tatjana Goranovic; Ewen A Griffiths; Rosio I Guerra Gronerth; Julio C Haidamus Monteiro; Timothy C Hardcastle; Andreas Hecker; Adrien M Hodonou; Orestis Ioannidis; Arda Isik; Katia A Iskandar; Hossein S Kafil; Souha S Kanj; Lewis J Kaplan; Garima Kapoor; Aleksandar R Karamarkovic; Jakub Kenig; Ivan Kerschaever; Faryal Khamis; Vladimir Khokha; Ronald Kiguba; Hong B Kim; Wen-Chien Ko; Kaoru Koike; Iryna Kozlovska; Anand Kumar; Leonel Lagunes; Rifat Latifi; Jae G Lee; Young R Lee; Ari Leppäniemi; Yousheng Li; Stephen Y Liang; Warren Lowman; Gustavo M Machain; Marc Maegele; Piotr Major; Sydney Malama; Ramiro Manzano-Nunez; Athanasios Marinis; Isidro Martinez Casas; Sanjay Marwah; Emilio Maseda; Michael E McFarlane; Ziad Memish; Dominik Mertz; Cristian Mesina; Shyam K Mishra; Ernest E Moore; Akutu Munyika; Eleftherios Mylonakis; Lena Napolitano; Ionut Negoi; Milica D Nestorovic; David P Nicolau; Abdelkarim H Omari; Carlos A Ordonez; José-Artur Paiva; Narayan D Pant; Jose G Parreira; Michal Pędziwiatr; Bruno M Pereira; Alfredo Ponce-de-Leon; Garyphallia Poulakou; Jacobus Preller; Céline Pulcini; Guntars Pupelis; Martha Quiodettis; Timothy M Rawson; Tarcisio Reis; Miran Rems; Sandro Rizoli; Jason Roberts; Nuno Rocha Pereira; Jesús Rodríguez-Baño; Boris Sakakushev; James Sanders; Natalia Santos; Norio Sato; Robert G Sawyer; Sandro Scarpelini; Loredana Scoccia; Nusrat Shafiq; Vishalkumar Shelat; Costi D Sifri; Boonying Siribumrungwong; Kjetil Søreide; Rodolfo Soto; Hamilton P de Souza; Peep Talving; Ngo Tat Trung; Jeffrey M Tessier; Mario Tumbarello; Jan Ulrych; Selman Uranues; Harry Van Goor; Andras Vereczkei; Florian Wagenlehner; Yonghong Xiao; Kuo-Ching Yuan; Agnes Wechsler-Fördös; Jean-Ralph Zahar; Tanya L Zakrison; Brian Zuckerbraun; Wietse P Zuidema; Fausto Catena Journal: World J Emerg Surg Date: 2017-08-01 Impact factor: 5.469
Authors: Beverley J Shea; Barnaby C Reeves; George Wells; Micere Thuku; Candyce Hamel; Julian Moran; David Moher; Peter Tugwell; Vivian Welch; Elizabeth Kristjansson; David A Henry Journal: BMJ Date: 2017-09-21