REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a minimally invasive method of stopping uncontrollable haemorrhage from severe injury. It involves inserting a small balloon catheter via the femoral artery in the groin, up into the aorta, the main blood vessel that leaves the heart and descends towards the feet. The procedure is used for patients who are rapidly bleeding to death. The principle is akin to applying a tourniquet to an area that was previously unreachable.
Around 50% of patients in shock from a pelvic fracture die before arriving, or immediately on arriving in the Emergency Department, before any meaningful intervention can be achieved. At the Royal London Hospital, we estimated around one person per month was dying of a catastrophic bleed who could potentially be saved by REBOA.
The procedure was first described in 1954 when it was attempted in three cases to save casualties in the Korean War. Unfortunately these early attempts were unsuccessful, as were many cases since then as the procedure was typically reserved for patients in or close to cardiac arrest, by which time the battle may already be lost. We felt sure that a more proactive approach, delivered at the roadside would save lives.
Thanks to new research, developments in equipment and an on-going drive to save these patients, the procedure has been refined and re-launched. It is performed in Emergency Departments in only a handful of hospitals worldwide and, until 2014, had never been performed out of hospital. London’s Air Ambulance is the first service to pioneer this procedure in the pre-hospital setting and in May 2014 the first pre-hospital REBOA was performed by the LAA team. The first procedure was performed on a gentleman who had fallen 15 metres and who was bleeding catastrophically from blood vessels in his pelvis. Currently we are using REBOA to treat pelvic haemorrhage (called Zone three REBOA),but we are developing the process to treat bleeds higher up in the body and potentially save a wider group of patients. This new way of delivering REBOA, known as Prehospital Zone One REBOA, will be delivered as part of a trial in 2020.
This procedure is increasingly being recognised as a feasible way to save patients who would otherwise die in the very early stages following an accident and interest is growing worldwide. We have spoken on the process internationally, formed a structured training, education and governance programme and we have developed a course called our PEER Course (Prehospital Emergency Endovascular Resuscitation).
Our team have been instrumental in the delivery of the REBOA procedure within hospitals throughout the UK, as part of the