STRATEGIES FOR CONTROLLING AORTIC HEMORRHAGE IN EXSANGUINATING ABDOMINAL TRAUMA: A SYSTEMATIC REVIEW COMPARING REBOA VERSUS RESUSCITATIVE THORACOTOMY FOR VASCULAR COMPLICATIONS, TRANSFUSION REQUIREMENTS AND RETURN OF SPONTANEOUS CIRCULATION (ROSC)

Background: bad abdominal hemorrhage with the need for aortic occlusion is a big problem in trauma care. Resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative thoracotomy (RT) with aortic cross-clamping are the two main methods of controlling hemorrhage immediately, but evidence checking these two methods is conflicting. This systematic review checks REBOA to RT for vascular problems, transfusion requirement and ROSC in adult folks with exsanguinating abdominal trauma. Methods: Using the PRISMA guidelines, we searched the literature in the databases: MEdlne, Embase, Cochrane CENTRAL, Scopus and Web of Science from January 2000 to December 2024. Included studies straight compared REBOA with RT in adults with hemorrhage of the abdominal/pelvic region requiring occlusion of the aorta. Primary outcomes were vascular problems, 24 hr transfusion requirement and ROSC. Secondary outcomes were death, time to occlusion and non-vascular complications. Data were synthesized in a narrative way with quantitative presentation of individual study results. Results: Twenty-three studies with 8247 patients (REBOA: 2417; RT: 5830) were eligible. Vascular complication chances with REBOA were 4.2-19.2% among studies compared to 1.1-8.3% among studies with RT. Access site artery injury was found in 4.0% of REBOA patients compared to 1.1% with RT. Distal Limb Ischemia that Required fix occurred in 3.0% of REBOA patients compared with 1.3% with RT. Twenty-four hour transfusion requirements were consistently less with REBOA with mean PRBC transfusion reductions of 2.4 - 4.2 units across studies. ROSC rates in traumatic cardiac arrest were higher with REBOA (36 - 60%) than RT (18 - 33%). REBOA (711 minutes) and RT (48minutes) had a longer time to aortic occlusion. Mortality at hospital discharge ranged from 37 - 88% with REBOA and 45 - 93% with RT at the end of studies with high heterogeneity based on patient population. Conclusions: REBOA has benefits in regards to transfusion reduction and ROSC achievement in comparison to RT, especially in penetrating trauma and traumatic cardiac arrest. These advantages are however offset by the jump in the risk of vascular complications such as access site injuries and limb ischemia. These findings support the approach to do selective based on clinical context, mechanism of injury and institutional capabilities.