Resuscitative endovascular balloon occlusion of the aorta versus resuscitative thoracotomy in traumatic non-compressible torso hemorrhage: A structured narrative systematic review.

In 30 seconds

This structured narrative systematic review compared resuscitative endovascular balloon occlusion of the aorta (REBOA) with resuscitative thoracotomy (RT) for adult patients with traumatic non-compressible torso hemorrhage. It included 13 comparative studies: one randomised trial and 12 observational studies, with approximately 7942 patients. Observational studies consistently associated REBOA with lower in-hospital mortality, but serious or critical risk of bias from confounding makes the evidence very uncertain. The UK-REBOA trial stopped early for potential harm, with a posterior OR of 1.58 (95% CrI 0.72-3.52).

Key findings

• Across 12 observational studies, REBOA was associated with lower in-hospital mortality, but confounding risk was serious or critical and certainty very low.
• The UK-REBOA randomised trial stopped early for potential harm (posterior OR 1.58, 95% CrI 0.72-3.52).
• The review included 13 studies (1 RCT, 12 observational; n ≈ 7942).

Why it matters

REBOA is less invasive than RT, but the apparent mortality advantage in observational comparisons cannot establish that it improves survival. The randomised trial’s early stopping for potential harm reinforces uncertainty. Distinguishing treatment effect from confounding is important when interpreting these comparisons and when considering which patients might benefit from either intervention.

What to keep in mind

Most evidence was observational and at serious or critical risk of bias from confounding; the single randomised trial stopped early.