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

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.