Resuscitative endovascular balloon occlusion of the aorta versus resuscitative thoracotomy in traumatic non-compressible torso hemorrhage: A structured narrative systematic review
In brief
Balloon aortic occlusion linked to lower trauma mortality, but trial raised harm concern
Across 13 studies involving about 7,942 adults with severe torso bleeding, observational research linked balloon aortic occlusion to lower in-hospital mortality than emergency chest surgery. But those studies had serious or critical risk of bias, and the only randomized trial stopped early over potential harm. Whether the procedure benefits selected patients remains uncertain.
- Journal
- American journal of surgery (Q1)
- Published
- 22 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Areeba Imran, Aymen Arain, Danny Lee
- PMID
- 42828812
- DOI
- 10.1016/j.amjsurg.2026.117234
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 5 October 2026): REBOA vs resuscitative thoracotomy in non‑compressible torso hemorrhage
Abstract
BACKGROUND: Non-compressible torso hemorrhage (NCTH) is a leading cause of preventable trauma death. Resuscitative thoracotomy (RT) has served as salvage intervention, while resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a less invasive alternative, though evidence remains discordant. METHODS: Following PRISMA 2020 guidelines, we searched PubMed, Embase, and Cochrane CENTRAL through March 2026 for comparative studies of REBOA versus RT in adult NCTH patients. Risk of bias was assessed using ROBINS-I and RoB 2. A structured narrative synthesis was performed. RESULTS: Thirteen studies were included (1 RCT, 12 observational; n ≈ 7942). Observational studies consistently associated REBOA with lower in-hospital mortality, though all were at serious or critical risk of bias from confounding (GRADE: very low). The UK-REBOA trial was stopped early for potential harm (posterior OR 1.58, 95% CrI 0.72-3.52). CONCLUSION: Observational evidence associates REBOA with lower mortality, but this reflects confounding rather than causal benefit. Equipoise remains for randomized trials in patients with isolated infradiaphragmatic hemorrhage and preserved cardiac activity.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.