Meta-Analysis: Comparative Analysis of Resuscitative Endovascular Balloon Occlusion of The Aorta (Reboa) Versus Thoracotomy in Trauma Patients

Author(s): Abdul Rahman Mohamed Elmohamed, Saad Mohammed, Kunj Sanjay Badiani, Muaz Rehman, Mohammed Ashik Cheerangal, Muhammad Shazin Vatta Kandy, Ihsan Farooq Akbar

Background: Mortality rate is very high in cases of traumatic non-compressible torso hemorrhage (NCTH). To restore perfusion and control bleeding in NCTH, two emergency procedures are used which are, Resuscitative Thoracotomy (RT) and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). The survival rate, side effects and applications of REBOA and RT are analyzed and compared in this meta-analysis.

Methods: Data was obtained from fifteen studies including cohort studies, registry analysis and meta-analysis, published between 2006 and 2025. Complication rates, subgroup outcomes and mortality odds ratios (ORs) were assessed. The PRISMA methodology was used. Forest and funnel plots were created, and I2 was used to measure heterogeneity.

Results: With a pooled OR of 0.79, this meta-analysis demonstrated that REBOA was linked to a significantly lower in-hospital mortality rate than RT. The patients with abdominal or pelvic injuries, elders and patients without pre-hospital cardiac arrest showed particularly significant survival benefits. While the rates of major complications were comparable, minor access related issues were more common with REBOA. The overall effect favored REBOA, even though there was significant heterogeneity (I² ≈ 100%). These findings support REBOA as a less invasive and effective alternative to RT in selective trauma cases.

Conclusion: When administered early and in the correct anatomic zones, REBOA shows promising results as compared to RT in certain trauma patients with NCTH. The advantages of REBOA, however, are time-sensitive and reliant on institutional preparedness, patient selection and training.