Assessing the role of REBOA in the management of hemodynamically unstable pelvic fractures: a systematic review and meta-analysis.
European Journal of Trauma and Emergency Surgery · 2026-02-16 · Meta-analysis
Abstract
PURPOSE: The role of zone III resuscitative endovascular balloon occlusion of the aorta (REBOA) in the management of hemodynamically unstable pelvic fractures remains controversial, with conflicting evidence regarding its impact on mortality and a lack of consensus on optimal treatment strategies. The aim of this systematic review was to assess the impact of the addition of zone III REBOA alongside conventional treatment modalities. METHOD: PubMed, Embase, Scopus and the Cochrane Library were systematically searched on October 2024 and December 2025. Primary outcomes included in-hospital mortality, mortality within 24 h and post-24-hour mortality. Data was pooled using a random-effects model. Outcomes are reported as risk ratios (RR) or mean difference (MD) with 95 per cent confidence intervals. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: A total of seven retrospective cohort studies were included, representing a total of 837 patients (REBOA: 343, non-REBOA: 494). REBOA use was associated with significantly higher in-hospital mortality (RR 1.44, 95% CI 1.13–1.78; p = 0.0006) and higher 24-hour mortality (RR 1.90, 95% CI 1.13–3.20; p = 0.0292). Mortality beyond 24 h did not differ significantly between groups (RR 1.30, 95% CI 0.55–3.04; p = 0.4). CONCLUSION: In patients with hemodynamically unstable pelvic fractures, zone III REBOA is associated with increased early and overall in-hospital mortality and substantially higher early transfusion requirements, without demonstrable benefit in complications or length of stay. Given the limited certainty of evidence from retrospective studies, further prospective investigations are needed to better clarify the role of zone III REBOA.
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