Elsevier

Resuscitation

Volume 107, October 2016, Pages 135-138
Resuscitation

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

https://doi.org/10.1016/j.resuscitation.2016.06.029Get rights and content

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.

Introduction

This case report describes the first use known to the authors of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting for uncontrolled haemorrhage. London's Air Ambulance (LAA) is a prehospital physician-paramedic trauma service that operates from an urban major trauma centre. The aim of the service is to provide rapid, effective treatment to seriously injured patients as soon as possible after injury. The medical team is trained in advanced pre-hospital procedures including rapid sequence intubation and pre-hospital thoracotomy.

Section snippets

Background

Non-compressible torso haemorrhage (NCTH) is the leading cause of preventable trauma deaths.1 Pelvic fractures and junctional vascular injuries are two important sources of NCTH and are particularly challenging to manage. These injuries are associated with rapid exsanguination with mortality rates approaching 50 percent.2, 3 Even in well developed trauma systems, up to half of these deaths occur pre-hospital, or soon after arrival in hospital, before any opportunities for definitive haemorrhage

Summary of case

In May 2014 LAA was tasked to a severely injured 32-year-old male who had fallen approximately 15 m landing on concrete. The doctor-paramedic team arrived 34 min after the injury.

Their primary survey examination revealed a patent airway, tachypnoea (30 breaths/min), and profound shock. The patient was pale and sweaty, tachycardic (130 bpm) with delayed capillary refill, weak carotid pulse and no recordable blood pressure. He was drowsy but responsive to voice. Examination of his head, chest and

Discussion

Mortality in exsanguinating trauma patients is high.1, 8 Injured patients who deteriorate to cardiac arrest secondary to hypovolaemia have extremely poor outcomes.9 There is a cohort of patients who require very rapid control of torso haemorrhage if they are to survive.2, 10 Although the proportion of trauma patients who require such rapid haemorrhage control is relatively low, they equate to a significant number of potentially preventable deaths per year. A recent review of the TARN (The

Conclusion

The role of REBOA is yet to be clearly defined. However, this case demonstrates the feasibility of pre-hospital Zone 3 REBOA, which in this case successfully controlled severe NCTH with survival to hospital for definitive haemorrhage control, in a patient deemed likely to exsanguinate prior to arrival at hospital.

This case suggests that pre-hospital REBOA is feasible and may have a role in managing severe NCTH in the pre-hospital setting.

Conflict of interest statement

No conflict of interest to declare.

References (21)

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  • On-site placement of resuscitative endovascular balloon occlusion of the aorta (REBOA) in a hemorrhagic shock patient: A successful endeavor involving long-distance air transport

    2022, American Journal of Emergency Medicine
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    Resuscitative endovascular occlusion of the aorta (REBOA) is a minimally invasive aortic blockade procedure. Although several cases have been documented on prehospital REBOA placement [1--4]. these reports largely focus on traumatic hemorrhage and the existing guidelines do not clearly define prehospital REBOA placement indications or occlusion time.

  • Prehospital aortic blood flow control techniques for non-compressible traumatic hemorrhage

    2021, Injury
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    The patient survived the transport to the hospital for emergency angioembolization and subsequent surgery. He was discharged after 52 days in the hospital, with a full recovery [61]. Recently, Lamhaut et al. [62] described the first civilian prehospital Zone I REBOA deployment by the Service d'Aide Medicale Urgente in Paris.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.06.029.

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