REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a novel and 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.
Today, still 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 feel sure that a more proactive approach, delivered at the roadside will 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 recently, 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. Currently we are using REBOA to treat pelvic haemorrhage but we are developing the process to treat bleeds higher up in the body and potentially save a wider group of patients.
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 are developing a training package for other clinicians and services.
For personal, non-commercial use only. Any other use requires written permission from The Institute of Pre-Hospital Care.
To learn more about our educational piece - Pre-Hospital and Emergency Endovascular Resusciation (PEER) Course - follow this link.