Table 3 Potential candidates for pre-hospital REBOA
Study | Methods | Participants | Outcomes | Conclusions |
|---|---|---|---|---|
Trauma studies | ||||
Thabouillot 2018 [13] (France) | Retrospective cross-sectional study Analysis of all the trauma patients registered in the Paris Fire Brigade database January 1st, 2014, to December 31st, 2014 | N = 1159 Eligible candidates: Adults with suspected abdominal, pelvic, or junctional bleeding, uncontrolled hemorrhagic shock (SBP < 90 mmHg) and cardiac arrest or pressor amine requirement ≥ 5 mg/h | Main outcome: 3.2% (37/1159) were considered candidates for pre-hospital REBOA Other outcomes: - Median ISS 29 (25–34) - The global out-of-hospital death rate with conventional management was 83.8% (31/37) - The mechanisms of injury were falls (59.5%), car crash (21.6%), train collisions (10.8%), and stab/gunshot wounds (8.1%) | This is the first study to propose the eligibility criteria for pre-hospital REBOA, which includes high dose amine use, emphasizing that REBOA should be used as a last resource and only when benefits outweigh risks |
Henry 2019 [14] (United States) | Retrospective cohort study Review of full autopsies of patients with traumatic cardiac arrest who arrived at a Level I Trauma Center in Los Angeles January 2014 to March 2018 | N = 198 Eligible candidates: Those who, based on autopsy findings, suffered abdominal organ injuries and/or pelvic fractures as a source of NCTH, with no severe head injuries (AIS ≥ 3) | Main outcome: 13.6% (27/198) were considered candidates for pre-hospital REBOA Other outcomes: -Median ISS 22 (17–29) - Most of these patients had severe injuries (AIS ≥ 3): 85.2% (23/27) had abdominal solid organ injuries and 65.4% (17/27) had pelvic fractures | This study concludes that there is a potential role for REBOA in prehospital settings and that some clinical variables could identify the patients that most likely will benefit from this lifesaving intervention |
Non-trauma study | ||||
Brede 2020 [6] (Norway) | Retrospective cohort study Analysis of the patients with OHCA captured by the Norwegian Cardiac Arrest Registry January 1st, 2016, to December 31st, 2018 | N = 8339 Eligible candidates: Those aged 18 to 75 years, with witnessed cardiac arrest, suspected non-traumatic etiology, ambulance response time < 15 min and CPR duration > 30 min “Potentially eligible” candidates: Same indications as above but CPR duration between 15–30 min | Main outcome: 8.6% (720/8339) were considered candidates for pre-hospital REBOA Other outcomes: - 6.3% (528/8339) were considered “potentially eligible” candidates for pre-hospital REBOA - The cohort overall survival at 30-day follow-up was 14%, with good neurological outcomes in 83% of the cases - Presumed non-traumatic cardiac arrest causes were cardiac in 1543 (78.6%), respiratory in 276 (14.1%), overdose/intoxication in 69 (3.5%) and strangulation in 76 (3.9%) | This study suggests that there is sufficient patient population in Norway to study REBOA as an adjunct treatment in non-traumatic OHCA |