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Meta-Analysis
. 2018 Sep;85(3):626-634.
doi: 10.1097/TA.0000000000001978.

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

Ramiro Manzano-Nunez  1 , Claudia P Orlas, Juan P Herrera-Escobar, Samuel Galvagno, Joseph DuBose, Juan J Melendez, Jose J Serna, Alexander Salcedo, Camilo A Peña, Edison Angamarca, Tal Horer, Camilo J Salazar, Valeria Lopez-Castilla, Juan Ruiz-Yucuma, Fernando Rodriguez, Michael W Parra, Carlos A Ordoñez
Affiliations
Meta-Analysis

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

Ramiro Manzano-Nunez et al. J Trauma Acute Care Surg. 2018 Sep.

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 = 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 = 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.

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