Vascular Access Complications Associated with the Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Adult Trauma Patients: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is gaining popularity worldwide for managing hypotensive trauma patients. Vascular access complications related to REBOA placement have been reported, with some cases resulting in permanent morbidity. Multiple REBOA series have been reported since the most recent systematic review published in 2018. This study aimed to capitalize on the increase in literature to further describe and estimate the incidence of REBOA-associated vascular access complications. METHODS: We searched Medline, EMBASE, Scopus, and CINAHL for studies reporting vascular access complications of REBOA in adult trauma patients. All studies were screened by 2 independent researchers according to criteria established a priori. For studies with significant overlap in populations, only the largest study was included. Meta-analysis of proportions was performed to estimate the incidence of vascular access complications using the Freeman-Tukey double-arcsine transformation. RESULTS: We identified 24 studies totaling 720 patients. The total incidence of vascular access complications was 6% (95% CI 3% to 11%) with moderate heterogeneity (Tau2 = 0.02, I2 = 62%) Complications included limb ischemia (n = 29), dissection (n = 15), limb loss (n = 6), bleeding (n = 3), pseudoaneurysm (n = 3), and embolization (n = 1). Planned subgroup analysis and metaregression yielded similar results by degree of bias, primary provider specialty, sheath-size 7 F or larger, and year of publication. CONCLUSION: Among 24 studies reporting REBOA placement in adult trauma patients worldwide, the incidence of vascular access complications was 6%. These results should serve as a benchmark to improve the quality of REBOA implementation efforts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.033 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".