UK-REBOA

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial.

Jansen JO, Hudson J, Cochran C, et al. JAMA 2023 · PMID 37824132 · doi:10.1001/jama.2023.20850

Question

Does adding REBOA to standard care in the emergency department reduce death in trauma patients with exsanguinating haemorrhage?

Design

Pragmatic Bayesian multicentre RCT in UK major trauma centres, funded by the NIHR.

Patients

Adult trauma patients with suspected exsanguinating haemorrhage below the diaphragm unresponsive to resuscitation.

Intervention

REBOA plus standard major trauma care

Comparison

Standard major trauma care alone

Primary outcome

All-cause mortality at 90 days

Key result

REBOA did not reduce mortality; the Bayesian analysis showed a high probability of harm, with more deaths, many occurring early from bleeding.

Limitations

Recruitment was smaller than planned and stopped early, and operators had limited REBOA experience, which may not reflect expert centres.

Impact on practice

Does not support routine emergency department REBOA in UK trauma care; haemorrhage control should focus on rapid definitive surgical or radiological intervention.