Has the balloon really burst? Analysis of "the UK-REBOA randomized clinical trial".

BACKGROUND: Uncontrolled hemorrhagic shock is a leading cause of early death after injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) represents a paradigm shift in achieving hemodynamic stability and its implementation still remain controversial in different settings. The recently published UK-REBOA Randomized Clinical Trial aimed to determine the effectiveness of REBOA in patients with hemorrhagic shock, concluding its increased mortality compared with standard care alone. METHODS: An adjustment of the statistical analysis was performed and a comprehensive analysis was proposed to address the study's limitations and demonstrate that these conclusions cannot be considered as benchmarks. RESULTS: Primary and secondary outcomes were analyzed using Bayesian logistic regression and generalized linear models suitable for the outcome distribution. No statistically significant differences were observed between the two groups for the primary outcome (p-value 0.3341) nor in most of the secondary outcomes. The results of the principal stratum analyses (to account for intercurrent events) also did not show significant differences after the statistical analysis tests. CONCLUSION: It cannot be stated that REBOA increases mortality compared with standard care alone in trauma patients with exsanguinating hemorrhage. Further studies and adequate simulation training programs in REBOA are critical to its successful implementation within a trauma system and to identify the optimum settings and patients.

Stent Management of Leaks After Bariatric Surgery: a Systematic Review and Meta-analysis.

BACKGROUND: Despite the low rates of complications of bariatric surgery, gastrointestinal leaks are major adverse events that increase post-operative morbidity and mortality. Endoscopic treatment using self-expanding stents has been used in the therapeutic management of these complications with preliminary good results. METHODS: We performed a systematic review and meta-analysis of self-expanding stents placement for the management of gastrointestinal leaks after obesity surgery. Overall proportion of successful leak closure, stent migration, and reoperation were analysed as primary outcomes. Secondary outcomes were patients' clinical characteristics, duration and type of stent, other stent complications, and mortality. RESULTS: A meta-analysis of studies reporting stents was performed, including 488 patients. The overall proportion of successful leak closure was 85.89% (95% CI, 82.52-89.25%), median interval between stent placement and its removal of 44 days. Stent migration was noted in 18.65% (95% CI, 14.32-22.98%) and the overall proportion of re-operation was in 13.54% (95% CI, 9.94-17.14%). The agreement between reviewers for the collected data gave a Cohen's κ value of 1.0. No deaths were caused directly by complications with the stent placement. CONCLUSIONS: Endoscopic placement of self-expanding stents can be used, in selected patients, for the management of leaks after bariatric surgery with a high rate of effectiveness and low mortality rates. Nevertheless, reducing stent migration and re-operation rates represents an important challenge for future studies.

Bull horn injuries. A 40-year retrospective study with 572 patients.

BACKGROUND: Although bullfighting festivals were traditionally attributed to the cultural idiosyncrasies of the Ibero-American people, they also exist world-wide. METHODS: A retrospective study was conducted, reviewing the medical records of patients treated on our service for bull horn injuries between January 1978 and December 2019. RESULTS: There were 572 admissions due to bull horn injuries. 54 of these patients had multiple injuries. The average annual admission was 13.6 patients. The most frequent injuries were located in the lower extremities, perineum, and abdomen. Forty-seven laparotomies were performed, revealing intra-abdominal visceral impairment on 39 occasions. The most frequently injured organs were the intestine and liver. The most frequent complications were skin devitalisation, infection and post-operative eventration. The recorded mortality was 0.87%. CONCLUSION: We wish to highlight the importance of injuries caused by bull horns worldwide. These are high-impact injuries with specific intrinsic characteristics that require regulated medical and surgical care.