Scoping review and recommendation to establish standardized best practices for resuscitative endovascular balloon occlusion of the aorta in combat casualties: A North Atlantic Treaty Organization exploratory team report
Bibliographic record
Abstract
ABSTRACT: Truncal hemorrhage is a major cause of combat-related mortality, with delayed surgical access likely increasing future fatalities. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to temporarily control hemorrhage until surgery can be performed. Differences in management, device selection, and training among North Atlantic Treaty Organization (NATO) allies can compromise patient care during deployments. In response, NATO formed a multinational team of REBOA experts to make recommendations for future efforts to standardize care and enhance interoperability. The team held virtual meetings to assess field use, materiel solutions, training programs, and persistent problems. A scoping review was conducted to identify relevant military medicine studies, including those using preclinical combat injury models, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews framework. Contributions came from published work, gray literature, and expert input. Experts from seven countries participated, identifying 52 key studies, 47 published combat uses, and 14 unpublished cases from Ukraine. Of the multitude of available catheters, only one had recent combat use cases for prolonged partial occlusion, and none were published. Unlike other countries, the United States and the United Kingdom possessed military-specific REBOA guidelines; however, both were outdated and assumed air superiority. Training programs varied significantly, with no standardized approach across NATO. Courses differed in the instructional method, intended audience, content, competencies, and refresher frequency; none included partial REBOA. As such, the Ukrainian military was reliant on training from catheter manufacturers. Arterial access challenges continue to hinder REBOA use. There is a critical need for ongoing data collection from combat to inform best practices. Given the rapid evolution of REBOA devices, the changing landscape of war, and limited published literature on these topics, further NATO research efforts should be applied to develop uniform guidance for REBOA in combat environments.
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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 | 0.119 | 0.314 |
| Meta-epidemiology (narrow) | 0.003 | 0.003 |
| Meta-epidemiology (broad) | 0.010 | 0.014 |
| Bibliometrics | 0.034 | 0.026 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.011 | 0.013 |
| Open science | 0.008 | 0.008 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.008 | 0.002 |
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".