LAA Performs Pioneering Roadside Occlusive Balloon Surgery

The London Air Ambulance (LAA; United Kingdom) has performed the world’s first roadside resuscitative endovascular balloon occlusion of the aorta (REBOA) to control internal bleeding.

REBOA is a proactive circulatory support method for hypotensive patients at risk of cardiovascular collapse. It works by controlling or preventing further blood loss via a balloon fed into the inferior part of the aorta and then inflated, temporarily cutting off blood supply to damaged blood vessels. Occlusion of the thoracic aorta can provide inflow control in patients with exsanguinating abdominal trauma, whereas occlusion of the infrarenal aorta can control pelvic hemorrhage.

The pioneering technique could prevent trauma patients bleeding to death from severe pelvic hemorrhage, an injury most commonly associated with cycling incidents and falls from height. The technique was developed over two year in conjunction with the Royal London Hospital (RLH; United Kingdom), the LAA’s home base, which continues treatment of the patient with further hospital interventions.

“We believe the use of REBOA can lead to a reduction in the number of patients who quite simply bleed to death before they have the chance to get to hospital where there are highly developed systems for stabilizing and preventing blood loss,” said Gareth Davies, MD, medical director of the LAA. “Our aim is to provide our patients with the world’s most innovative and effective pre-hospital care. Being able to effectively manage blood loss at the scene is a significant advancement in pre-hospital medicine.”

“We have to stop people bleeding to death—it's one of the world's biggest killers. Over 2.5 million people bleed to death from their injuries each year around the world,” added Prof. Karim Brohi, consultant vascular and trauma surgeon at RLH. “While it sounds relatively simple it is an extremely difficult technology to deliver in the emergency department in hospital, never mind at the roadside. We are excited about the potential for REBOA to reduce death and suffering after trauma and will continue to evaluate and develop the technology into the future.”

LAA is a registered charity that functions as a mobile emergency department in life-threatening, time-critical situations, and carries a senior doctor (in addition to a paramedic) at all times on a helicopter, thus reducing the death rate in severe trauma by 30%–40%. Based in RLH, the helicopter can reach any patient inside the M25 London orbital road within 15 minutes. Missions commonly involve serious road traffic collisions, falls from height, stabbings and shootings, industrial accidents, and incidents on the rail network. The team can provide advanced life-saving medical interventions, including open heart surgery, blood transfusion, and anesthesia at the scene.

Related Links:
London Air Ambulance
Royal London Hospital