Outcomes and Evidence
Type
AdditionConfidence
72%
Created
Mar 27, 2026
Evidence
2 sources
Rationale
Two articles were evaluated for integration into this 'Outcomes and Evidence' section. Article 36542395 (Cralley 2026, registry, relevance 53/100, flagged): This is a registry-based comparative study of Zone 1 REBOA versus resuscitative thoracotomy — directly relevant to the existing bullet on comparative observational analyses. It was added as a co-citation alongside Brenner M, et al to reinforce the existing claim about mixed, selection-dependent results. No new prose was required; the existing text already accurately characterizes this class of evidence. Confidence: 0.70 (registry study, flagged status). Article 37824132 (Jansen 2026, UK-REBOA RCT, relevance 42/100, needs-human-review): This is the UK-REBOA trial, the first adequately powered RCT of REBOA in trauma, published in JAMA. Despite a lower relevance score, its methodological significance (RCT in a field dominated by observational data) and its null survival finding make it important to acknowledge in an 'Outcomes and Evidence' section. However, because the recommendation is 'needs-human-review' and the trial's findings are contested in the literature regarding patient selection and procedural timing, the integration explicitly flags this for human review rather than presenting it as settled evidence. A new bullet was added under REBOA outcomes to capture this. Confidence: 0.72 (RCT, but contested interpretation and needs-human-review flag). Citation density was kept consistent with the existing section (one to two citations per bullet). The widget hint, all headings, and existing citations were preserved exactly. No European/US guideline balance issue arises here as neither article is a society guideline.
Evidence
Content Changes
<!-- type: evidence --> **Evidence landscape** Most endovascular trauma management (EVTM) outcome data are **observational** (registries, administrative datasets, and single-center series). Interpretation requires attention to indication, timing, comparator selection, and survivorship bias. [@trauma2016-aorta] [@matsumura2020] **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 show mixed results and are highly selection-dependent. [@brenner2018-survival] [@cralley2026-h] - The UK-REBOA randomized clinical trial (RCT) — the first adequately powered RCT of REBOA in trauma — found no statistically significant survival benefit for emergency department REBOA versus standard resuscitation in patients with exsanguinating hemorrhage, though the trial has been subject to debate regarding patient selection and procedural timing. This result underscores the importance of rigorous trial design in this population and warrants careful human review before incorporation into practice recommendations. [@jansen2026-j] **Hybrid/endovascular strategy outcomes (what “success”"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 are important for benchmarking, governance, and complication surveillance. [@mani2020] See also: [[Vascular Trauma|Ch. 15]] for extremity injury outcomes and shunt/bypass benchmarks.