Efficacy and safety of resuscitative endovascular balloon occlusion of the aorta (REBOA) in traumatic hemorrhagic shock: a meta-analysis

Traumatic hemorrhagic shock is associated with high mortality. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a temporary hemorrhage control technique; however, its clinical outcomes and complication profile remain inadequately defined. We aimed to conduct a meta-analysis to evaluate the efficacy and safety of REBOA in patients with traumatic hemorrhagic shock. A systematic search of MEDLINE (via PubMed), EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted up to August 14, 2025. All studies comparing the use of REBOA versus no-REBOA or versus resuscitative thoracotomy (RT) were included. The included studies comprised randomized controlled trials (RCTs) and propensity score-matched (PSM) studies. Study quality was assessed using the Cochrane Risk of Bias tool 2.0 (RoB 2.0) for the included randomized controlled trial and the ROBINS-I tool for non-randomized studies. The primary outcomes were mortality, including in-hospital mortality, 24-hour mortality, and emergency department (ED) mortality. Secondary outcomes comprised complications such as acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), and deep vein thrombosis (DVT). A total of 12 studies involving 7,269 patients were included. Compared with no-REBOA, REBOA was associated with higher in-hospital mortality, increased ED mortality, and a greater incidence of AKI. When compared to RT, REBOA was associated with lower in-hospital mortality. No statistically significant differences were observed between the REBOA group and control groups in other outcome measures. In patients with traumatic hemorrhagic shock, the use of REBOA may be associated with harmful effects due to its significant physiological burden, necessitating careful evaluation of its applicability in clinical practice. Although REBOA appeared to demonstrate a survival advantage over RT, this finding should be interpreted with caution given that RT is typically reserved for patients in extremis or cardiac arrest.