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Resuscitation. 2016 Oct;107:135-8. doi: 10.1016/j.resuscitation.2016.06.029. Epub 2016 Jul 1.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage.

Author information

  • 1Emergency Medicine and Pre-Hospital Care, The Royal London Hospital, London's Air Ambulance, Essex and Herts Air Ambulance, The Institute of Pre-Hospital Care, Whitechapel, London E1 1BB, United Kingdom. Electronic address: samy.sadek@bartshealth.nhs.uk.
  • 2Anaesthetia and Pre-Hospital Care, Honorary Professor of Trauma and Pre-hospital Emergency Medicine, Bristol, Honorary Senior Research Fellow, QMUL, London's Air Ambulance, Blizzard Institute, Queen Mary University of London, United Kingdom.
  • 3Cardiothoracic and Trauma Anaesthetist, Edinburgh Royal Infirmary, NHS Lothian, London's Air Ambulance, Department of Anaethesia and Critical Care, Royal Infirmary of Edinburgh, 51 Little France Crescent, EH16 4SA, United Kingdom.
  • 4Centre for Trauma Sciences, Queen Mary University, London, United Kingdom.
  • 5Hepatobiliary and Liver Transplant Anaesthesia, The Royal Free Hospital, London's Air Ambulance, United Kingdom.
  • 6Pre-Hospital Care and Emergency Medicine, London's Air Ambulance, Honorary Senior Lecturer, Trauma Sciences, QMUL, Helipad, The Royal London Hospital, Whitechapel, London E1 1BB, United Kingdom.

Abstract

This report describes the first use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting to control catastrophic haemorrhage. The patient, who had fallen 15 meters, suffered catastrophic internal haemorrhage associated with a pelvic fracture. He was treated by London's Air Ambulance's Physician-Paramedic team. This included insertion of a REBOA balloon catheter at the scene to control likely fatal exsanguination. The patient survived transfer to hospital, emergency angio-embolization and subsequent surgery. He was discharged neurologically normal after 52 days and went on to make a full recovery. The poor prognosis in catastrophic torso haemorrhage and novel endovascular methods of haemorrhage control are discussed. Also the challenges of Pre-Hospital REBOA are discussed together with the training and governance required for a safe system.

KEYWORDS:

Aortic occlusion; Catastrophic Haemorrhage; Endovascular Haemorrhage Control; Exsanguination; Hypovolaemia; NCTH; Non-compressible torso haemorrhage; Pelvic Fracture; Pre-Hospital Care; REBOA; Resuscitative Endovascular Balloon Occlusion of the Aorta; Shock; Trauma; Uncontrolled Haemorrhage; junctional vascular injuries

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