Prehospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and cardiac arrest: a systematic review

OBJECTIVES: Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides temporary hemorrhage control and optimizes perfusion to vital organs. Despite increasing use in civilian and combat prehospital settings, there is limited consensus on its application or effectiveness. Research has shown mixed effects on mid- to long-term survival, and the inherently high mortality risk among patients receiving REBOA complicates the interpretation of literature. This systematic review consolidates evidence on REBOA use in prehospital and transport medicine settings. METHODS: We conducted a systematic review of multiple databases to identify studies describing REBOA use in the prehospital or transport medicine setting. Two independent reviewers screened against inclusion and exclusion criteria. The risk of bias was assessed via the ROBINS-I tool. The primary outcomes were feasibility of REBOA and survival rates. Secondary outcomes included complications and other ​​relevant safety outcomes. Owing to anticipated heterogeneity, a narrative synthesis was conducted. RESULTS: following REBOA, although survival rates and complications varied widely. When reported, survival to hospital discharge was 44% (14/32) in civilian trauma cases, 4% (1/25) in civilian OHCA cases, and 88% (7/8) in civilian interfacility transport cases. No survival data were available for REBOA in combat cases. Survival rates were correlated with patient selection criteria and the nature of injuries. CONCLUSIONS: The current evidence for REBOA use in the prehospital and transport medicine settings is limited by the small number of cases in most existing studies, the lack of control groups in all but one study, and limited reporting of patient-focused outcomes.