Resuscitative Endovascular Balloon Occlusion of the Aorta in the management of patients due to major trauma

Abstract

Abstract Introduction: Non-compressible haemorrhage among trauma patients is the number one cause of preventable deaths, as it leads to hemodynamic instability and hypotension. The appropriate management of trauma patients with uncontrolled bleeding leads to improved patient outcomes and survival. This study evaluated the effectiveness and reliability of the REBOA in the control of non-compressible bleeding in patients with major trauma. Methods: The study adopted a systematic review, and high-quality studies were used to show the effectiveness, safety, and use of REBOA in trauma patients. The inclusion and exclusion criteria used were studies that evaluated the use and effectiveness of REBOA and were published from 2015 to date in the English language. The key search terms that were used were; REBOA, endovascular, bleeding, haemorrhage, uncontrolled, non-compressible, multi-trauma, trauma, intra-abdominal, intracranial, massive, patients, effectiveness, and reliability. These were adapted for use in PubMed, MEDLINE, CINAHL, and EMBASE databases. Quality appraisal of the included studies was done with the CASP tool, and narrative synthesis was used to extract data from the studies. Results: Seventeen studies were included in the systematic review. The results obtained showed that early initiation of REBOA in trauma patients with non-compressible haemorrhage leads to improved hemodynamic stability and improved systolic pressure, a significant factor in the survival of the patients. Also, the REBOA technique prevented continued haemorrhage from fractures to the non-compressible regions such as the pelvic ring, truncal and intra-abdominal areas. Conclusion: REBOA technique is safe and effective in the control of haemorrhage in trauma patients with non-compressible bleeding. Future studies are required to indicate the effects of occlusion time, place, and zone of aortic occlusion using a large patient population.