Written by Rebecca DiFabio
Spoon Feed
This meta-analysis found improved mortality in non-compressible torso hemorrhage with REBOA over resuscitative thoracotomy (RT), though at the cost of higher complication rates.
REBOA rather than RT? Not so fast…
The current data on RT vs. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is highly heterogeneous. With trauma remaining a major cause of death globally, there continue to be new avenues for research.
This meta-analysis of 14 observational studies evaluated outcomes of RT with supraceliac aortic cross-clamping vs. REBOA in hemorrhagic shock and traumatic cardiac arrest secondary to torso injuries. The REBOA population had an 83% mortality reduction compared to RT (OR 0.17, 95%CI 0.10-0.28; p<0.0001), also seen in both hemorrhagic shock and cardiac arrest subpopulations. Higher complication rates were reported with REBOA (OR 7.81, 95%CI 3.88-15.72; p<0.0001) and inconsistent times to aortic occlusion (AO), with most studies showing longer times to AO with REBOA.
While this is a good analysis of the current data on REBOA vs RT, the observational nature of the studies makes it impossible to exclude multiple confounding factors including indication, baseline differences, gestalt, transfusion practices, etc. There’s also significant heterogeneity in patient populations, clinician experience, and trauma protocols.
How does this change my practice?
Honestly, it won’t—at least, not yet. The most recent EAST guidelines from 2025 conditionally recommend for the use of REBOA with traumatic cardiac arrest due to suspected subdiaphragmatic bleeding, based upon level IV evidence. These critically ill trauma patients require close coordination with your local trauma system and an understanding of your department’s resources, protocols, and your own training. While this study presented important data, I suspect more high-quality data are needed before we see any sweeping changes to recommendations on RT vs. REBOA.
Source
Resuscitative endovascular balloon occlusion of the aorta versus resuscitative thoracotomy for noncompressible torso hemorrhage: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2026 Mar 26. doi: 10.1097/TA.0000000000004962. Epub ahead of print. PMID: 41885281.
