Vascular disruption with concomitant hemorrhage is a leading cause of death in civilian and military trauma.^1,2 Experience from the wars in Iraq and Afghanistan has led to advances in resuscitation for hemorrhagic shock, with identification of optimum ratios of blood components to be used in this setting.^3-5 These new strategies are based on early and balanced administration of packed red blood cells (PRBCs), fresh frozen plasma (FFP), platelets, and cryoprecipitate to restore circulating volume and clotting factors.⁶ Despite these advances, the effectiveness of a medication to improve mortality in the setting of hemorrhagic shock has not been established.

Torso hemorrhage remains a leading cause of potentially preventable death within trauma, acute care, vascular, and obstetric practice. A proportion of patients exsanguinate before hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct designed to sustain the circulation until definitive hemostasis. A systematic review was conducted to characterize the current clinical use of REBOA and its effect on hemodynamic profile and mortality. A systematic review (1946-2015) was conducted using EMBASE and MEDLINE. Original studies on human subjects, published in English language journals, were considered. Articles were included if they reported data on hemodynamic profile and mortality. A total of 83 studies were identified; 41 met criteria for inclusion. Clinical settings included postpartum hemorrhage (5), upper gastrointestinal bleeding (3), pelvic surgery (8), trauma (15), and ruptured aortic aneurysm (10). Of the 857 patients, overall mortality was 423 (49.4%); shock was evident in 643 (75.0%). Pooled analysis demonstrated an increase in mean systolic pressure by 53 mm Hg (95% confidence interval, 44-61 mm Hg) following REBOA use. Data exhibited moderate heterogeneity with an I of 35.5. REBOA has been used in a variety of clinical settings to successfully elevate central blood pressure in the setting of shock. Overall, the evidence base is weak with no clear reduction in hemorrhage-related mortality demonstrated. Formal, prospective study is warranted to clarify the role of this adjunct in torso hemorrhage. Systematic review, level IV.

Hemorrhage resultant from vascular disruption remains the predominant cause of preventable battlefield mortality^1,2 and the leading cause of preventable death in civilian trauma.^3-5 Acute traumatic coagulopathy is associated with a 4-fold increase in mortality and is characterized by both anticoagulation and fibrinolysis.⁶ Fibrinolysis is a key protective or regulatory mechanism that prevents the extension of formed clot beyond the site of injury⁷ but may become pathologic following injury and shock.⁸ When present in the setting of trauma, excessive fibrinolysis (ie, hyperfibrinolysis) is associated with a mortality rate of 48% to 100%.^9-12