A Little Flow Goes a Long Way: A Systematic Review of Partial Versus Complete Resuscitative Endovascular Balloon Occlusion of the Aorta in the Hemorrhaging Trauma Patient
Description
This systematic review examines recent clinical evidence comparing partial versus complete resuscitative endovascular balloon occlusion of the aorta (REBOA) in adult trauma patients with noncompressible torso hemorrhage. While REBOA is an important intervention for hemorrhagic shock, complete aortic occlusion is associated with complications such as distal ischemia and end-organ injury. Partial REBOA (pREBOA) has emerged as a strategy to preserve distal perfusion while maintaining hemodynamic support.
This review analyzes studies published since 2021 to evaluate outcomes including mortality, acute kidney injury, and resuscitation requirements. Findings suggest that pREBOA may reduce mortality, decrease blood product utilization, and lower complication rates, though results are not consistent across all studies. Current evidence is limited to observational data and may be influenced by bias, emphasizing the need for independent randomized controlled trials to guide clinical practice.
Abstract
Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an established intervention for noncompressible torso hemorrhage, but complete aortic occlusion carries risks of distal ischemia and end-organ injury. Partial REBOA (pREBOA) has emerged as a technique to maintain some distal perfusion while providing proximal hemodynamic support. This systematic review update evaluates clinical evidence published since the 2021 Russo et al systematic review comparing partial versus complete REBOA outcomes.
Methods: A targeted literature search of PubMed/MEDLINE, OVID, and Scopus identified clinical studies published between January 2021 and February 2026 examining partial versus complete REBOA in adult trauma patients requiring Zone 1 aortic occlusion. Five studies meeting inclusion criteria were analyzed for mortality, acute kidney injury, and resuscitation outcomes.
Results: Five studies encompassing over 2400 trauma patients were included. The largest registry analysis (Dewey et al; n=921) demonstrated that partial REBOA was associated with significantly lower mortality compared to complete REBOA (adjusted hazard ratio [HR], 1.18 for cREBOA vs pREBOA; 95% CI, 1.01-1.39; P=.04). A second registry analysis (Meyer et al; n=955) found that pREBOA was associated with 27.8% fewer packed red blood cell transfusions (P=0.001) and 50% less crystalloid use (P<0.001). One single-center study (Hunt et al; n=68) reported significantly lower acute kidney injury rates with pREBOA (6.7% vs 34.0%; P<0.05). However, not all studies demonstrated mortality differences, and the evidence remains limited by observational designs.
Conclusions: Emerging clinical evidence suggests partial REBOA may offer advantages over complete occlusion, including reduced mortality, lower blood product requirements, and decreased acute kidney injury. However, all available studies are observational, and independently-funded randomized controlled trials are needed to establish definitive clinical recommendations.
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