A few months ago, we spoke about REBOA-resuscitative endovascular balloon occlusion of the aorta. You might have thought to yourself, “Interesting, but I'll never be doing that.” Well, not so fast, on today's podcast we speak to the retrieval doctor that performed the first REBOA in the field.
REBOA in the Field and the ED
In London, the idea of bringing REBOA to the field and the ED was made reality by Gareth Davies. Dr. Davies is Chair and Medical Director of the London Air Ambulance (London HEMS), one of the best HEMS services in the world. In the first part of the podcast, we hear how he conceptualized and enacted the plan to bring REBOA to the field.
The First Prehospital REBOA
Then we speak with Jonny Price, Anesthesia and Intensive Care registrar doing a secondment in HEMS. At the time of the events of the podcast, he was flying with London HEMS. His story of the first prehospital REBOA is fascinating.
Special thanks to Cliff Reid for making these interviews possible.
Update
Here is the hot-off-the-press article on the technique: Resuscitation 2016 Jul 1; Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: An additional resuscitation option for uncontrolled catastrophic haemorrhage.S Sadek, D J Lockey, R Lendrum, Z Perkins, J Price, G E Davies PMID: 27377669
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Professor
Nassau University Medical Center
No conflicts of interest (coi).
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This just makes me proud to be involved in prehospital care. What a win for the ideology that critical interventions at scene do matter and racing to the trauma center is not the one and only important thing to do.
absolutely!
Awesome talk, thanks!
Heartiest congratulations to the entire team at London’s Air Ambulance, and gratitude for pushing the envelope.
Unbelievable! Here in South Africa we still have a fragmented prehospital system with overwhelming patient volumes and acuities, let alone any aeromedical system we can write about, and we have EDs that are struggling with staffing and resource limitations, and our colleagues abroad are inspiring us to achieve greater things for our patients against all adversity. I salute you guys!
Great job. Put’s out of hospital Ultrasound on the radar for us in EMS.
Hello
I was the first Ambulance Paramedic on scene for this call. It was clear to me (since the first moment I put my eyes on the patient) that he required advance medical care, so I activated LAA about 30 sec after my arrival.
It was a pleasure and a privilege to witness this procedure been done. Great podcast, I was not aware the patient was eventually discharged.
R Ambrosino
Paramedic
LAS
Great move Ricardo! Thanks for writing in.
An amazing story. I have checked with Maryland Institute of Trauma. They are only teaching REBOA to surgeons. Does anyone know where EM physicians could obtain training?
Marilyn,
They are releasing a narrow-bore REBOA catheter this year that will go through a small sheath. As soon as that happens, Shock Trauma will accept emergency physicians for training.
Hopefully remote paramedics will soon be on that list!
What is the Reboa..role in the severe pelvic fracture algorithm? Before angiography in the ideal hybrid room or before o.r. for pelvic packing of the pelvic hematoma?
STC places it in the trauma bay and then moves to IR either in the suite or in the hybrid OR–Packing has moved down on the priority list