Article Figures & Data
Figures
- Figure 1
PICAR framework for systematic review of REBOA patient selection clinical practice guidelines. CFA, common femoral artery; PICAR, population, intervention, comparison, attributes, and recommendation characteristics; REBOA, resuscitative endovascular balloon occlusion of the aorta.
- Figure 2
PRISMA flow sheet. REBOA, resuscitative endovascular balloon occlusion of the aorta.
- Figure 3
Consensus and Variability in REBOA Patient Selection Criteria. Gray indicates the inclusion of this detail in the algorithm, white indicates the absence of explicit inclusion, and “X” indicates this detail included as a contraindication. CFA, common femoral artery; NA, not applicable; pREBOA, partial REBOA; REBOA, resuscitative endovascular balloon occlusion of the aorta; SBP, systolic blood pressure.
Tables
- Table 1
Publications presenting algorithms for REBOA patient selection (2015–2022)
Year First author (institution) Data sources cited Methodology Scope limitations Comments on early CFA access? Contraindications to REBOA Criteria for REBOA patient selection 2018 Brenner (ACSCOT and ACEP)24 Yes Joint policy statement based on published data, best evidence, and expert opinion None No None specified.
Traumatic life-threatening hemorrhage below the diaphragm in patients in hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.
Patients arriving in arrest from injury.
2019 Borger van der Burg (multicenter)7 No Delphi consensus (3 rounds, 43 experts responding) None Yes Major bleeding in the neck or proximal to the left subclavian artery.
Traumatic abdominopelvic hemorrhage.
Trauma patients with initial SBP <90 who do not respond to resuscitation.
Any trauma victim with ATLS class IV hypovolemic shock.
2020 Glaser (JTS)8 Yes Military guidelines Military No Severe blunt chest injury.
Profound shock or traumatic arrest due to penetrating neck, chest, or extremity injury.
SBP <90 and transient or no response to initial resuscitation in blunt trauma or penetrating abdominal/pelvic/junctional injury.
Traumatic arrest (blunt or penetrating) based on injury location and CPR time.
2020 Brenner (UC Riverside and Shock Trauma)22 Yes Not specified Traumatic cardiac arrest Yes None specified.
Blunt or non-thoracic penetrating injury.
Hemorrhage location unknown or below the diaphragm.
Consider with hemorrhage location in the thorax in combination with resuscitative thoracotomy.
2020 Ordoñez (Cali, Colombia)16 17 Yes Institutional algorithm None Yes None specified.
Non-compressible torso hemorrhage.
Blunt or penetrating mechanism.
SBP <90 and transient responder to resuscitation.
2022 Inaba (WTA)20 Yes Society consensus None Yes Major thoracic vascular injury.
Sustained hypotension refractory to resuscitation.
2021 Johnson (multicenter)25 Yes Consensus after multicenter observational study None Yes Thoracic hemorrhage.
SBP <90 and partial or non-responder.
2021 Castellini (Milan, Italy)26 Yes Not specified None No Suspicion of thoracic aorta injury.
Hypotensive trauma patients with suspected torso hemorrhage.
Non-responders to resuscitation.
Positive FAST or positive pelvic X-ray.
2021 Hadley (Denver Health)15 Yes Institutional algorithm None No Thoracic hemorrhage.
SBP <80 and hemorrhage location.
Traumatic arrest with pelvic or extremity hemorrhage.
2022 Nagashima (Japan)27 Yes Not specified None Yes Near/recent cardiac arrest.
Possible aortic injury.
Hypotensive partial or non-responder.
ACEP, American College of Emergency Physicians; ACSCOT, American College of Surgeons' Committee on Trauma; ATLS, advanced trauma life support; CFA, common femoral artery; CPR, cardiopulmonary resuscitation; FAST, focused assessment with sonography in trauma; JTS, Joint Trauma System; REBOA, resuscitative endovascular balloon occlusion of the aorta; SBP, systolic blood pressure; UC, University of California; WTA, Western Trauma Association.
- Table 2
Partial REBOA rollout collaborative institutional algorithms for REBOA patient selection
Institution Data sources cited Trigger for early CFA access Contraindications to REBOA Criteria for REBOA patient selection Ernest E Moore Shock Trauma Center at Denver Health (Denver, Colorado) No SBP <100: 5Fr.
SBP <90: 7Fr.
SBP <80: REBOA.
Active thoracic bleeding.
SBP <80 and cavitary triage.
Grady Memorial Hospital (Atlanta, Georgia) No Concern for truncal hemorrhage.
SBP <90, received 2 units of blood product, or transient transponder.
Not specified.
SBP <90.
Transient responder to resuscitation.
Non-responder to 2 units of blood.
Traumatic cardiac arrest.
Grant Medical Center (Columbus, Ohio) No SBP <90.
Transient responder.
Profound, refractory shock.
OHCA with ROSC.
Not specified.
SBP <90 with inadequate response to resuscitation.
Profoundly hypotensive.
Hypovolemic cardiac arrest and not beyond salvage.
University of Maryland Shock Trauma Center (Baltimore, Maryland) No None specified.
Not specified.
Persistently hypotensive or transient responder.
Low suspicion for aortic injury.
Evidence of vascular continuity from CFA to thoracic aorta.
Attending trauma surgeon or intensivist discretion.
St Michael’s Hospital (Toronto, Ontario) Yes Pelvic fracture.
Positive FAST and SBP <90.
Not specified.
Traumatic arrest for abdominal/pelvic/junctional hemorrhage provided reversible cause suspected.
SBP <90 and transient or non-responder with positive abdominal FAST or pelvic X-ray (blunt) or abdominal/pelvic/junctional injury (penetrating).
University Medical Center New Orleans (New Orleans, Louisiana) Yes SBP <90 and partial or non-responder.
Blunt: possible aortic injury on CXR.
Penetrating: possible supradiaphragmatic or cardiac injury.
Blunt: SBP <90 and partial or non-responder.
Penetrating: SBP <90 and truncal/lower extremity injury (in OR).
In OR: SBP <90, transient responder, profound refractory shock, or prehospital CPR with ROSC.
Vanderbilt University Medical Center (Nashville, Tennessee) No SBP <80 with a pulse.
Thoracic aortic injury.
Transient or non-responder.
CFA, common femoral artery; CPR, cardiopulmonary resuscitation; CXR, chest X-ray; FAST, focused assessment with sonography in trauma; Fr, French; OHCA, out of hospital cardiac arrest; OR, operating room; REBOA, resuscitative endovascular balloon occlusion of the aorta; ROSC, return of spontaneous circulation; SBP, systolic blood pressure.
