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

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

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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aorta*
  • Balloon Occlusion / methods*
  • Emergency Medical Services / methods*
  • Endovascular Procedures / methods*
  • Hemorrhage* / diagnosis
  • Hemorrhage* / etiology
  • Hemorrhage* / physiopathology
  • Hemorrhage* / therapy
  • Humans
  • Injury Severity Score
  • Male
  • Multiple Trauma / complications*
  • Multiple Trauma / diagnosis
  • Multiple Trauma / physiopathology
  • Pelvic Bones* / diagnostic imaging
  • Pelvic Bones* / injuries
  • Shock, Hemorrhagic
  • Treatment Outcome