Toracotomía de resucitación vs REBOA en trauma aórtico torácico. Revisión Sistemática

Abstract

Background: Traumatic rupture of the thoracic aorta is a severe vascular injury with an 80% mortality rate and a 15% survival rate; it is considered one of the leading causes of non-compressible torso hemorrhage, characterized by massive thoracic bleeding. The conventional treatment involves thoracotomy with aortic clamping. However, due to the increase in complications, mortality, and prolonged hospital stays, research has shifted towards methods or devices that could improve the prognosis of patients with severe trauma, such as Resuscitative endovascular balloon occlusion of the aorta (REBOA), which would be an effective alternative for patients with hemorrhagic shock secondary to non-compressible torso hemorrhage. Objective: To determine the effectiveness and safety of the endovascular occlusion technique compared to aortic clamping in treating patients with thoracic aortic injury. Methods: The PRISMA 2020 method was applied, with MeSH term connections and Boolean operators ("thoracotomy" OR "aortic trauma" OR "thoracotomy with aortic clamping") AND ("REBOA" OR "aortic balloon occlusion"), using databases: Web of Science, Cochrane, PubMed, SciELO, Elsevier, Redalyc, Ovid, Springer, ScienceDirect, and SINERGIA Journal. These sources met the inclusion and exclusion criteria, and the results were presented in tables. Results: A total of 305 records, including 5,666 participants, were retrieved from various databases using Boolean operators. Characteristics, interventions, and populations were evaluated, highlighting variability and methodological quality, as well as bias, to determine the effectiveness of these surgical techniques ultimately. Keywords: hemorrhage, occlusion, REBOA, thoracotomy.