Outcomes and Evidence
Applied
Type
ModificationConfidence
95%
Created
Mar 27, 2026
Evidence
2 sources
Rationale
The integration of these two articles is critical for this section. The UK-REBOA trial (Jansen 2026) is the first major RCT in the field and significantly changes the 'Evidence landscape' by showing potential harm, which contradicts earlier observational optimism. The Cralley 2026 article provides more granular registry data on the comparison between REBOA and RT, specifically identifying CPR status as a key modifier of survival benefit. Abbreviations like RT and CPR were expanded on first use as per instructions.
Evidence
Content Changes
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<!-- type: evidence --> **Evidence landscape** MostHistorically, most endovascular trauma management (EVTM) outcome data arehave been **observational** (registries, administrative datasets, and single-center series). [@trauma2016-aorta] [@matsumura2020] Interpretation requires attention to indication, timing, comparator selection, and survivorship bias. [@trauma2016-aorta]However, [@matsumura2020]the evidence base is evolving with the completion of the first major randomized clinical trial (RCT) in the field, the UK-REBOA trial, which has introduced high-quality data that may challenge previous observational findings regarding the benefit of resuscitative endovascular balloon occlusion of the aorta (REBOA) [@jansen2026-f]. **resuscitative endovascular balloon occlusion of the aorta (REBOA) outcomes** - Registries demonstrate feasibility and define complication patterns; outcome signals vary by indication and practice environment. [@trauma2016-aorta] - Comparative observational analyses versus resuscitative thoracotomy (RT) show mixed results and are highly selection-dependent. [@brenner2018-survival] Recent registry data suggest that Zone 1 REBOA is associated with improved survival compared to RT in patients who do not require cardiopulmonary resuscitation (CPR), though this benefit is not observed in patients already requiring CPR [@cralley2026-d]. - The UK-REBOA RCT demonstrated an increase in 90-day mortality among patients receiving REBOA compared to standard care (54% vs 42%), highlighting the potential for harm and the critical importance of patient selection and system-level implementation [@jansen2026-f]. **Hybrid/endovascular strategy outcomes (what “success” means)** Beyond survival, meaningful endpoints include: - Time to hemorrhage control - Blood product utilization - Organ failure and ischemic complications (renal/visceral/limb) - Need for fasciotomy or access repair - Limb salvage and functional outcome (especially in extremity/junctional trauma). [@rasmussen2011-vascular] **Why registries remain central** Given case heterogeneity and low event frequency at single centers, multi-institution registries areremain important for benchmarking, governance, and complication surveillance.surveillance, especially as they provide real-world context to RCT findings. [@mani2020] See also: [[Vascular Trauma|Ch. 15]] for extremity injury outcomes and shunt/bypass benchmarks.