You are in your Team House or BAS. You have given FDP, Whole blood, TXA calcium and don’t have much left despite the few units from the walking blood bank. Your patient continues to bleed internally. Nothing in the chest or upper abdomen. Probably pelvic. Damn. MEDEVAC is en route. They will have some blood too. You just need your patient to hold on for another hour before he gets to surgery…
Dr. Joe DuBose is an Air Force Trauma Surgeon who recognized early in his career that hemorrhage was the number one killer of potentially survivable patients. This led him to a fellowship in vascular surgery and, as Dennis put it made him a guru in the emerging technology that allows a catheter to be placed in the femoral artery and snaked up past a bleed in the pelvis, abdomen and even chest where a balloon is then inflated cutting off all blood flow below that point. Dr. DuBose was the first to do This in the ED using a newer version that had a small enough diameter that a vascular repair would not be required after use. It is simply placed through a central line and removed as such later on. This is called REBOA or Resuscitative Endovascular Balloon Occlusion of the Aorta. As you can imagine this is not without limits and complications if done improperly.
In this episode we explore the usefulness and limitations of this strategy in deployed settings and discuss the use of REBOA by non-physician providers in austere situations. He has written several articles on use of the REBOA and it is now one of the most promising and controversial adjuncts available for hemorrhage control of bleeding inside the box of the thorax, abdomen and pelvis. In order to do this o e would likely have to be within an hour of a facility that can repair the retired vessel as the lactic acid and other toxins would quickly build up causing a massive repercussion injury. To this end he discusses his strategy for partial REBOA during resuscitation that would leave the balloon partially inflated allowing a clot to strengthen and circulation distal to the balloon.
Before getting into our talk, here is a quick demonstration from Prytime’s YouTube channel:
Now on to the podcast:
Read Joe’s recent article in the Journal of Trauma: How I do it Partial REBOA Joe DuBose
Here is the SMACC(Social Media and Critical Care) Chicago talk by Dr. Deborah Stein
Let us know what you think in the comments below!