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      Resuscitative endovascular balloon occlusion of the aorta (REBOA): a scoping review protocol concerning indications—advantages and challenges of implementation in traumatic non-compressible torso haemorrhage

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          Abstract

          Introduction

          Haemorrhage remains the leading cause of preventable death in trauma. Damage control measures applied to patients in extremis in order to control exsanguinating bleeding from non-compressible torso injuries use different techniques to limit blood flow from the aorta to the rest of the body. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is regaining momentum recently as an adjunct measure that can provide the same results using less invasive approaches. This scoping review aims to provide a comprehensive understanding of the existing literature on REBOA. The objective is to analyse evidence and non-evidence-based medical reports and to describe current gaps in the literature about the best indication and implementation strategies for REBOA.

          Methods and analysis

          Using the five-stage framework of Arksey and O’Malley’s scoping review methodology as a guide, we will perform a systematic search in the following databases: MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS from the earliest available publications. The aim is to identify diverse studies related to the topic of REBOA. For a comprehensive search, we will explore organisational websites, key journals and hand-search reference lists of key studies. Data will be charted and sorted using a descriptive analytical approach.

          Ethics and dissemination

          Ethics approval is not necessary as the data are collected from publicly available sources and there will be no consultative phase. The results will be disseminated through presentations at local, national, clinical and medical education conferences and through publication in a peer-reviewed journal.

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          Most cited references2

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          Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man.

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            Resuscitative Endovascular Balloon Occlusion of the Aorta in trauma: a systematic review of the literature

            Aims Resuscitative endovascular balloon occlusion of the aorta has been a hot topic in trauma resuscitation during these last years. The aims of this systematic review are to analyze when, how, and where this technique is performed and to evaluate preliminary results. Methods The literature search was performed on online databases in December 2016, without time limits. Studies citing endovascular balloon occlusion of the aorta in trauma were retrieved for evaluation. Results Sixty-one articles met the inclusion criteria and were selected for the systematic review. Overall, they included 1355 treated with aortic endovascular balloon occlusion, and 883 (65%) patients died after the procedure. In most of the included cases, a shock state seemed to be present before the procedure. Time of death and inflation site was not described in the majority of included studies. Procedure-related and shock-related complications are described. Introducer sheath size and comorbidity seems to play the role of risk factors. Conclusions Resuscitative endovascular balloon occlusion of the aorta is increasingly used in trauma victim resuscitation all over the world, to elevate blood pressure and limit fluid infusion, while other procedures aimed to stop the bleeding are performed. High mortality rate is probably due to the severity of the injuries. Time and place of balloon insertion, zone of balloon inflation, and inflation cutoff time are very heterogeneous.
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              Author and article information

              Journal
              BMJ Open
              BMJ Open
              bmjopen
              bmjopen
              BMJ Open
              BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
              2044-6055
              2019
              3 February 2019
              : 9
              : 2
              : e027572
              Affiliations
              [1 ] departmentDepartment of Trauma and Acute Surgical Care , McGill University Health Centre , Montreal, Quebec, Canada
              [2 ] departmentFaculty of Medicine , McGill University , Montreal, Quebec, Canada
              [3 ] departmentDepartment of Surgery , Medical Research Institute, Alexandria University , Alexandria, Egypt
              [4 ] departmentDepartment of Surgery , Royal Canadian Medical Services , Montreal, Quebec, Canada
              Author notes
              [Correspondence to ] Dr Omar Bekdache; omar.bekdache@ 123456mail.mcgill.ca
              Author information
              http://orcid.org/0000-0002-2236-7722
              Article
              bmjopen-2018-027572
              10.1136/bmjopen-2018-027572
              6368000
              30782953
              dbcbe219-b241-45d8-b699-6bec7f26a2d6
              © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

              This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

              History
              : 29 October 2018
              : 17 December 2018
              : 19 December 2018
              Categories
              Surgery
              Protocol
              1506
              1737
              1349
              Custom metadata
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              Medicine
              trauma management,resuscitative endovascular balloon occlusion of the aorta,damage control measures in trauma,therapeutic aortic occlusion,trauma resuscitation

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