Balloons on the battlefield: REBOA implementation in the UK Defence Medical Services

2021 ◽  
pp. bmjmilitary-2021-001925 ◽  
Author(s):  
Max E R Marsden ◽  
A M Buckley ◽  
C Park ◽  
N Tai ◽  
P Rees
Keyword(s):  
Damage Control ◽  
Balloon Occlusion ◽  
Control Technique ◽  
Medical Services ◽  
Damage Control Resuscitation ◽  
Arterial Access ◽  
Haemorrhage Control ◽  
The Uk ◽  
Standing Start ◽  
Endovascular Balloon Occlusion

Established in 2018, the Defence Endovascular Resuscitation (DefER) group recognised that resuscitative endovascular balloon occlusion of the aorta (REBOA) offered an option to improve survival in battle casualties dying from haemorrhage, particularly in remote and austere surgical settings. Following a successful jHub opportunity assessment, DefER purchased training and operational kit at pace. By 1 April 2019, the first forward surgical group undertook a bespoke endovascular training and assessment package. Results of the pilot were presented back to a jHub 4* Innovation Board, which initially awarded £500 000 to fund the project to full implementation. Med Op Cap provided a solution to establish REBOA as a core capability on to the 370 modules. REBOA catheters and arterial access kit are now available to deployed Role 2 facilities across defence as an adjunct to damage control resuscitation in specific circumstances. REBOA has, from a standing start, gained pan-Defence Medical Services (DMS) endorsement and has been integrated into deployed damage control resuscitation. To establish a new resuscitation capability across all Role 2 platforms within 15 months of inception represents implementation at pace. This agility was unlocked by empowering clinicians to develop the platform in conjunction with commercial procurement. This article describes how this innovative pathway facilitated the rapid introduction of a lifesaving haemorrhage control technique to equip DMS clinicians.

scholarly journals Intravascular ultrasound, performed during resuscitative endovascular balloon occlusion of the aorta (REBOA), confirms correct balloon deployment and haemostasis - a potential solution for remote, austere and military settings

2018 ◽  
Vol 104 (1) ◽  
pp. 12-17
Author(s):  
P S C Rees ◽  
A M Buckley ◽  
S A Watts ◽  
E Kirkman
Keyword(s):  
Intravascular Ultrasound ◽  
Guide Wire ◽  
Damage Control ◽  
Abdominal Ultrasound ◽  
Balloon Occlusion ◽  
Control Technique ◽  
Military Trauma ◽  
Haemorrhage Control ◽  
Potential Applicability ◽  
Endovascular Balloon Occlusion

AbstractIntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is rapidly evolving as an emergency haemorrhage control technique. It has wide potential applicability in remote and austere settings, and following military trauma where prolonged field care might be required. However, rapid confirmation of balloon delivery is a challenge which relies on estimates derived from anatomical measurements or trans-abdominal ultrasound. In addition, confirmation of adequate balloon expansion is difficult. Intravascular ultrasound (IVUS) offers a solution to these two issues, making REBOA a deliverable therapy in the pre-hospital and early hospital settings.MethodsIn an animal model of severe ballistic trauma, following characterisation of the technique, an IVUS-REBOA device was configured, combining a peripheral angioplasty balloon and a digital coronary IVUS catheter. This was introduced via a sheath into the femoral vessel over a conventional angioplasty guide wire.ResultsReal time IVUS imaging allowed confirmation of delivery of the balloon to the aorta, and also demonstrated full apposition once deployed. Furthermore, using ChromaFlo imaging, the device confirmed loss of pulsatile flow in the aorta after deployment, correlating with loss of transduced femoral pressure traces. Post-mortem examination confirmed correct anatomical balloon placement.SummaryFor the first time, in a porcine pilot study, we have demonstrated that IVUS-REBOA is feasible and confirms both correct balloon placement and haemostasis. It has potential to offer advantages to REBOA operators especially during the pre-hospital and retrieval phases, and in the early phase of hospital delivered damage control resuscitation at remote locations.

Defence Medical Services’ REBOA training course

2021 ◽  
pp. bmjmilitary-2021-001926
Author(s):  
Max E R Marsden ◽  
C Park ◽  
J Barratt ◽  
N Tai ◽  
P Rees
Keyword(s):  
Training Programme ◽  
Balloon Occlusion ◽  
Medical Services ◽  
Skill Retention ◽  
Training Course ◽  
Challenges And Opportunities ◽  
Haemorrhage Control ◽  
Surgical Teams ◽  
The Uk ◽  
First Time

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) enables temporary haemorrhage control and physiological stabilisation. This article describes the bespoke Defence Medical Services (DMS) training package for effectively using REBOA. The article covers how the course was designed, how the key learning objectives are taught, participant feedback and the authors’ perceptions of future training challenges and opportunities. Since the inaugural training course in April 2019, the authors have delivered six courses, training over 100 clinicians. For the first time in the UK DMS, we designed and delivered a robust specialist endovascular training programme, with demonstrable, significant increases in confidence and competence. As a result of this course, the first DMS REBOA-equipped forward surgical teams deployed in June 2019. Looking to the future, there is a requirement to develop an assessment of skill retention and the potential need for revalidation.

scholarly journals REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting

2017 ◽  
Vol 164 (2) ◽  
pp. 72-76 ◽  
Author(s):  
Paul Rees ◽  
B Waller ◽  
A M Buckley ◽  
C Doran ◽  
S Bland ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Balloon Occlusion ◽  
Operating Table ◽  
Royal Navy ◽  
Future Directions ◽  
Haemorrhage Control ◽  
Aviation Operations ◽  
The Military ◽  
Endovascular Balloon Occlusion

Role 2 Afloat provides a damage control resuscitation and surgery facility in support of maritime, littoral and aviation operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a rapid, effective solution to exsanguinating haemorrhage from pelvic and non-compressible torso haemorrhage. It should be considered when the patient presents in a peri-arrest state, if surgery is likely to be delayed, or where the single operating table is occupied by another case. This paper will outline the data in support of endovascular haemorrhage control, describe the technique and explore how REBOA could be delivered using equipment currently available in the Royal Navy Role 2 Afloat equipment module. Also discussed are potential future directions in endovascular resuscitation.

scholarly journals Practical tips for performing resuscitative endovascular balloon occlusion of the aorta

2021 ◽  
pp. 102490792199442
Author(s):  
Sung Wook Chang ◽  
Dae Sung Ma ◽  
Ye Rim Chang ◽  
Dong Hun Kim
Keyword(s):  
Damage Control ◽  
Balloon Catheter ◽  
Common Femoral Artery ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Arterial Access ◽  
Occlusion Time ◽  
Sheath Insertion ◽  
Multiple Trauma Patients ◽  
Endovascular Balloon Occlusion

Background: Hemorrhage is the leading cause of death in trauma settings. Non-compressible torso hemorrhage, which is caused by abdominopelvic and thoracic injuries, is an important cause of subsequent organ dysfunction and poor outcomes in multiple trauma patients. The management of hemodynamically unstable patients with non-compressible torso hemorrhage has changed, and the concept of damage control resuscitation has been developed in the last decades. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) as a method of temporary stabilization is the modern evolution of bleeding control, and it is in the middle of a paradigm shift as a treatment for non-compressible torso hemorrhage. Despite its effectiveness in patients with hemorrhagic shock, the application of REBOA remains limited because of lack of experience and troubleshooting guidelines. Objectives: The aim of study was to provide useful tips for the implementing a step-by-step procedure for REBOA in various hospital settings and capabilities. Methods: We introduced REBOA procedures using a REBOA-customized 7 Fr balloon catheter through the animation models or radiography from preparation to access, catheter management, and device removal after procedure completed. Results: We have described REBOA procedures as follows: identification of the common femoral artery, arterial access for placement of a guidewire, precautions during a sheath insertion, guidewire and balloon positioning in the aorta, occlusion zones and adjustment of balloon location, REBOA strategy for extending the occlusion time, balloon deflation and removal, sheath removal, and medical records. Conclusion: We believe that the practical tips mentioned in this article will help in performing the REBOA procedure systematically and developing an effective REBOA framework.

Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Valentina Chiarini
Keyword(s):  
Trauma Center ◽  
Aortic Rupture ◽  
Damage Control ◽  
Aortic Injury ◽  
Balloon Occlusion ◽  
Traumatic Lesion ◽  
Abdominal Aortic ◽  
Aortic Injuries ◽  
Accepted Practice ◽  
Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

scholarly journals A successful hybrid operation for life-threatening hemorrhagic shock secondary to an iatrogenic ruptured pseudoaneurysm of the external iliac artery following percutaneous arterial access

2018 ◽  
Vol 14 (3) ◽  
Author(s):  
Takahiro Shoji ◽  
Hirohisa Harada ◽  
Shinji Yamazoe ◽  
Yoshihiro Yamaguchi
Keyword(s):  
Renal Artery ◽  
Iliac Artery ◽  
Arterial Embolization ◽  
External Iliac Artery ◽  
Vascular Trauma ◽  
Balloon Occlusion ◽  
Arterial Access ◽  
Iatrogenic Complications ◽  
Life Threatening ◽  
Endovascular Balloon Occlusion

Intravascular treatments such as arterial embolization and resuscitative endovascular balloon occlusion of the aorta are being increasingly performed in emergency cases, in addition to the increasing use of arterial access as an intensive care monitoring tool. Thus, arterial access-related complications are being commonly reported. A 40- year-old man with renal artery stenosis underwent renal artery stent placement via the left inguinal puncture approach. After the procedure, his groin was manually compressed to hemostasis for 30 min. He unexpectedly developed shock the following day, and computed tomography revealed a ruptured pseudoaneurysm of the left external iliac artery (EIA) following iatrogenic vascular trauma owing to an inappropriately performed groin puncture. We initially controlled the hemorrhage using endovascular balloon occlusion of the left EIA. Subsequently, the injured EIA was repaired using a direct suture. The postoperative course was uneventful. Herein, we evaluated the causes of iatrogenic complications and the effectiveness of our treatment strategy.

Resuscitative endovascular balloon occlusion of the aorta during non-ST elevation myocardial infarction: A case report

Trauma ◽  
2018 ◽  
Vol 21 (2) ◽  
pp. 147-151
Author(s):  
Eleanor E Curtis ◽  
Rachel M Russo ◽  
Eric Nordsieck ◽  
Michael Austin Johnson ◽  
Timothy K Williams ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Animal Studies ◽  
Case Reports ◽  
Balloon Occlusion ◽  
St Elevation Myocardial Infarction ◽  
Control Technique ◽  
Coronary Perfusion ◽  
Previous Trauma ◽  
St Elevation ◽  
Endovascular Balloon Occlusion

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a hemorrhage control technique that is increasingly being adopted for the management of noncompressible bleeding. In addition to limiting hemorrhage, REBOA increases blood flow to the heart, lungs, and brain. A small number of case reports and animal studies describe the use of REBOA to increase coronary perfusion during cardiopulmonary resuscitation. We report a case in which REBOA may have reversed ST-segment abnormalities during a Type II non-ST elevation myocardial infarction (NSTEMI) in a patient with previous trauma. We describe the presentation, course, and decision making that contributed to the use of REBOA in this case. Additionally, we will present a review of the literature on the effects of REBOA on coronary perfusion.

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