A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients. Issue 3 (September 2018)

• Record Type: Journal Article
• Authors: Manzano-Nunez, Ramiro; Orlas, Claudia P.; Herrera-Escobar, Juan P.; Galvagno, Samuel; DuBose, Joseph; Melendez, Juan J.; Serna, Jose J.; Salcedo, Alexander; Peña, Camilo A.; Angamarca, Edison; Horer, Tal; Salazar, Camilo J.; Lopez-Castilla, Valeria; Ruiz-Yucuma, Juan; Rodriguez, Fernando; Parra, Michael W.; Ordoñez, Carlos A.
• Is Part Of: Journal of trauma and acute care surgery. Volume 85:Issue 3(2018)
• Publication Date: 2018-09
• Subjects: Wounds and injuries -- REBOA -- endovascular procedures -- intraoperative complications -- benchmarking; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000001978
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: Serious complications related to groin access have been reported with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA). We performed a systematic review and meta-analysis to estimate the incidence of complications related to groin access from the use of REBOA in adult trauma patients. METHODS: We identified articles in MEDLINE and EMBASE. We reviewed all studies that involved adult trauma patients who underwent the placement of a REBOA and included only those that reported the incidence of complications related to groin access. A meta-analysis of proportions was performed. RESULTS: We identified 13 studies with a total of 424 patients. REBOA was inserted most commonly by trauma surgeons or emergency room physicians. Information regarding puncture technique was reported in 12 studies and was available for a total of 414 patients. Percutaneous access and surgical cutdown were performed in 304 (73.4%) and 110 (26.5%) patients, respectively. Overall, complications related to groin access occurred in 5.6% of patients (n = 24/424). Lower limb amputation was required in 2.1% of patients (9/424), of which three cases (3/424 [0.7%]) were directly related to the vascular puncture from the REBOA insertion. A meta-analysis that used the logit transformation showed a 5% (95% CI 3%–9%) incidence of complications without significant heterogeneity (LR test: χ 2 = 0.73, p = 0.2, Tau-square = 0.2). In a second meta-analysis, we used the Freeman–Tukey double arcsine transformation and found an incidence of complications of 4% (95% CI 2%–7%) with low heterogeneity ( I 2 = 16.3%). CONCLUSION: We found that the incidence of complications related to groin access was of 4–5% based on a meta-analysis of 13 studies published worldwide. Currently, there are no benchmarks or quality measures as a reference to compare, and thus, further work is required to identify these benchmarks and improve the practice of REBOA in trauma surgery. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level III. Abstract : Supplemental digital content is available in the text.