How many patients could benefit from REBOA in prehospital care? A retrospective study of patients rescued by the doctors of the Paris fire brigade

• Published in: BMJ military health 2018-08, Vol.164 (4), p.267-270
• Main Authors: Thabouillot, Oscar, Bertho, K, Rozenberg, E, Roche, N-C, Boddaert, G, Jost, D, Tourtier, J-P
• Format: Article
• Language: English
• Subjects: Abdomen; Casualties; Coronary vessels; Drug dosages; Hemorrhage; Hospitals; Injuries; Intervention; Ostomy; Patients; Teams; Traffic accidents & safety; Trauma; Veins & arteries
• ISSN: 0035-8665; 2633-3767; 2052-0468; 2633-3775
• DOI: 10.1136/jramc-2018-000915

IntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique to control haemorrhage by placing a retrograde catheter in an artery and inflating a balloon at its tip. This retrospective study aimed to evaluate the proportion of injured people who could potentially have benefited from this technique prior to hospitalisation, including on the scene or during transport.MethodsA retrospective analysis was conducted of all patients with trauma registered in the Paris Fire Brigade emergency medical system between 1 January and 31 December 2014. Inclusion criteria included all patients over 18 years of age with bleeding of supposedly abdominal and/or pelvic and/or junctional origin, uncontrolled haemorrhagic shock or cardiac arrest with attempted resuscitation.ResultsDuring this study period, a total of 1159 patients with trauma (3.2%) would have been eligible to undergo REBOA. Death on scene rate was 83.8% (n=31) and six patients had a beating heart when they arrived at the hospital. Ten out of the 37 patients had spontaneous circulatory activity. Among them, four people died on the scene or during transport. Thirty-six out of 37 patients were intubated, one benefited from the use of a haemostatic dressing and one benefited from a tourniquet.ConclusionsREBOA can be seen as an effective non-surgical solution to ensure complete haemostasis during the prehospital setting. When comparing the high mortality rate following haemorrhage with the REBOA’s rare side effects, the risk–benefit balance is positive. Given that 3% of all patients with trauma based on this study would have been eligible for REBOA, we believe that this intervention should be available in the prehospital setting. The results of this study will be used: educational models for REBOA balloon placement using training manikins, with an ultimate aim to undertake a prospective feasibility study in the prehospital setting.