Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhage Control in Trauma Patients: An Evidence-Based Review

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Abstract

Traditionally, resuscitative efforts for uncontrolled noncompressible torso hemorrhage are achieved by cross-clamping the proximal aorta via thoracotomy to deliver temporary hemodynamic stability during injury repair. A less commonly used method of promoting early resuscitation and hemorrhagic control in trauma patients is resuscitative endovascular balloon occlusion of the aorta (REBOA). The focus of this literature review is to examine the effectiveness of REBOA in the management of noncompressible pelvic hemorrhage when compared with traditional methods of hemorrhage control in trauma patients. A literature search was performed by using the PubMed database to explore studies that defined the efficacy of REBOA or compared the use of REBOA with resuscitative thoracotomy with aortic cross-clamping for hemorrhage control. Studies encompassed in the review included 3 experimental studies utilizing swine, 2 retrospective studies that reviewed data collected from procedures performed in empirical situations, and a case series that described the implementation of REBOA. Trauma patients with noncompressible torso hemorrhage that is intervened with REBOA have higher mean arterial pressures and systolic blood pressures, require fewer boluses of intravenous fluids and vasopressors, avoid severe acidosis and ischemia, and have significantly lower rates of mortality, thus ensuring enhanced long-term outcomes. Evidence suggests that hemodynamic stability, physiological effects, and mortality rates are improved in patients who receive REBOA for torso hemorrhage control when compared with traditional methods.

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