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Journal update
Journal update monthly top five
  1. Suresh Pillai1,
  2. Oliver Watson1,
  3. James Grégoire1,
  4. Siva Kakarla1,
  5. James Ellis1,
  6. James Ainsworth2,
  7. Katy Kumar1,
  8. Govind Oliver3,4
  1. 1 Emergency Department, Morriston Hospital, Swansea, UK
  2. 2 Ed Major Intensive Care Unit, Morriston Hospital, Swansea, UK
  3. 3 Wythenshawe Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  4. 4 Clinical Research Fellow, Grounded Research Team, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
  1. Correspondence to Dr Suresh Pillai, Emergency Department, Morriston Hospital, Swansea, SA6 6NL, UK; SureshKumar.GopalaPillai{at}wales.nhs.uk

https://doi.org/10.1136/emermed-2023-213793

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    This month’s update is by the Swansea Bay UHB ED team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlight the main findings, key limitations and clinical bottom line for each paper.

    The papers are ranked as:

    • Worth a peek—interesting, but not yet ready for prime time.

    • Head turner—new concepts.

    • Game changer—this paper could/should change practice.

    Emergency department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma patients with exsanguinating Haemorrhage by Jansen et al

    Topic: resuscitative endovascular balloon occlusion of the aorta, traumatic haemorrhage

    Outcome rating: head turner

    Resuscitative endovascular balloon occlusion of the aorta (REBOA) as a bridge to definitive interventions in patients with traumatic haemorrhage has been gaining popularity, although there has not been high-level evidence to support it.1

    This highly anticipated study is a prospective, multicentre, randomised, open-label, controlled trial of REBOA plus standard care compared with standard care alone conducted at 16 UK major trauma centres in adult trauma patients with life-threatening haemorrhage. Pragmatically, patients were recruited at the discretion of the senior physician. For those assigned to the treatment arm, physicians could deploy REBOA in the zone they saw fit. The trial ended early after a preplanned interim analysis found that the stopping rule for harm was met.

    90 patients were randomised, 89 were followed up. The median Injury Severity Score (ISS) was 41, and 97% had blunt trauma. In the REBOA arm, 54% patients died at 90 days compared with 42% in the standard care alone group (OR 1.58, 0.72 to 3.52). Death was higher in the REBOA arm at all interim time points. There were also more deaths …

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    Footnotes

    • Contributors SP and GO conducted the literature searches and selected papers. SP, OW, JG, SK, JE, JA, KK and GO drafted the summaries.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.