Resuscitative endovascular balloon occlusion of the aorta versus resuscitative thoracotomy in traumatic non-compressible torso hemorrhage: A structured narrative systematic review.

BACKGROUND

Non-compressible torso hemorrhage (NCTH) is a leading cause of preventable trauma death. Resuscitative thoracotomy (RT) has served as salvage intervention, while resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a less invasive alternative, though evidence remains discordant.

METHODS

Following PRISMA 2020 guidelines, we searched PubMed, Embase, and Cochrane CENTRAL through March 2026 for comparative studies of REBOA versus RT in adult NCTH patients. Risk of bias was assessed using ROBINS-I and RoB 2. A structured narrative synthesis was performed.

RESULTS

Thirteen studies were included (1 RCT, 12 observational; n ≈ 7942). Observational studies consistently associated REBOA with lower in-hospital mortality, though all were at serious or critical risk of bias from confounding (GRADE: very low). The UK-REBOA trial was stopped early for potential harm (posterior OR 1.58, 95% CrI 0.72-3.52).

CONCLUSION

Observational evidence associates REBOA with lower mortality, but this reflects confounding rather than causal benefit. Equipoise remains for randomized trials in patients with isolated infradiaphragmatic hemorrhage and preserved cardiac activity.