PMID- 34715536
OWN - NLM
STAT- MEDLINE
DCOM- 20220406
LR  - 20220406
IS  - 1095-8673 (Electronic)
IS  - 0022-4804 (Linking)
VI  - 270
DP  - 2022 Feb
TI  - Resuscitative Endovascular Balloon Occlusion of Aorta Versus Aortic 
      Cross-Clamping by Thoracotomy for Noncompressible Torso Hemorrhage: A 
      Meta-Analysis.
PG  - 252-260
LID - S0022-4804(21)00606-5 [pii]
LID - 10.1016/j.jss.2021.09.016 [doi]
AB  - BACKGROUND: The effect of resuscitative endovascular balloon occlusion of aorta 
      (REBOA) in lowering mortality rate compared to resuscitative thoracotomy (RT) is 
      inconclusive. In this updated systematic review and meta-analysis, we determined 
      the effectiveness of the two techniques in patients with noncompressible torso 
      hemorrhage (NCTH). MATERIALS AND METHODS: Online databases (PubMed, Embase, and 
      MEDLINE) were searched until April 23, 2021, for original articles investigating 
      the effect of REBOA on relevant outcomes (e.g., mortality in ED, mortality before 
      discharge, in-hospital mortality, length of hospital stay and length of ICU stay) 
      among NCTH patients in contrast to open aortic occlusion by RT. Data on baseline 
      characteristics and endpoints were extracted. Review Manager version 5.4.1 and 
      OpenMetaAnalyst were used for analyses. Risk ratios (RR) and the weighted mean 
      differences (WMD) with corresponding 95% confidence intervals were calculated. 
      RESULTS: Eight studies were included having 3241 patients in total (REBOA: 1179 
      and RT: 2062). The pooled analysis demonstrated that compared to RT, mortality 
      was significantly lower in the REBOA group in all settings: In emergency 
      department (ED) (RR 0.63 [0.45, 0.87], P = 0.006, I(2) = 81%), before discharge 
      (RR= 0.86 [0.75, 0.98], P = 0.03, I(2 =) 93%), and in-hospital mortality (RR 0.80 
      [0.68, 0.95], P = 0.009, I(2 =) 85%). Similarly, the length of ICU stay was 
      significantly lower in REBOA group (WMD = 0.50 [-0.48, 1.48], P = 0.32, I(2 
      =)97%). However, no significant differences were observed in the length of 
      hospital stay (WMD = 0.0 [-0.26, 0.26] P = 1). CONCLUSIONS: Our pooled analysis 
      shows REBOA to be effective in reducing mortality among NCTH patients. However, 
      due to limited studies, the positive findings should be viewed discreetly and 
      call for further investigation.
CI  - Copyright (c) 2021. Published by Elsevier Inc.
FAU - Khalid, Saad
AU  - Khalid S
AD  - Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan. 
      Electronic address: saadkhalidonly@gmail.com.
FAU - Khatri, Mahima
AU  - Khatri M
AD  - Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
FAU - Siddiqui, Mishal Shan
AU  - Siddiqui MS
AD  - Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
FAU - Ahmed, Jawad
AU  - Ahmed J
AD  - Department of Internal Medicine, Dow University of Health Sciences, Karachi, 
      Pakistan.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
DEP - 20211026
PL  - United States
TA  - J Surg Res
JT  - The Journal of surgical research
JID - 0376340
SB  - IM
MH  - Aorta/surgery
MH  - *Balloon Occlusion/methods
MH  - Constriction
MH  - *Endovascular Procedures/methods
MH  - Hemorrhage/etiology/therapy
MH  - Humans
MH  - Resuscitation/methods
MH  - *Shock, Hemorrhagic/therapy
MH  - Thoracotomy/methods
MH  - Torso
OTO - NOTNLM
OT  - Aortic cross-clamping
OT  - Meta-analysis
OT  - Noncompressible torso hemorrhage
OT  - REBOA
OT  - Resuscitative thoractomy
OT  - Systematic review
OT  - Truncal hemorrhage
EDAT- 2021/10/30 06:00
MHDA- 2022/04/07 06:00
CRDT- 2021/10/29 20:26
PHST- 2021/06/06 00:00 [received]
PHST- 2021/08/31 00:00 [revised]
PHST- 2021/09/23 00:00 [accepted]
PHST- 2021/10/30 06:00 [pubmed]
PHST- 2022/04/07 06:00 [medline]
PHST- 2021/10/29 20:26 [entrez]
AID - S0022-4804(21)00606-5 [pii]
AID - 10.1016/j.jss.2021.09.016 [doi]
PST - ppublish
SO  - J Surg Res. 2022 Feb;270:252-260. doi: 10.1016/j.jss.2021.09.016. Epub 2021 Oct 
      26.