London’s Air Ambulance first to perform roadside balloon surgery

London’s Air Ambulance (LAA) has become the first organisation to perform roadside balloon surgery to control internal bleeding. The technique, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), was first used in the UK at The Royal London Hospital, to control haemorrhage in trauma patients.

REBOA works by controlling or preventing further blood loss. The balloon is fed into the bottom end of the aorta, and then inflated, cutting off blood supply to damaged blood vessels. Patients who undergo REBOA by LAA are then transported rapidly to the Royal London Hospital to undergo further vital interventions. The technique can be used on patients suffering severe pelvic haemorrhage, an injury most commonly associated with cycling incidents and falls from height.

Dr Gareth Davies, medical director for LAA, commented on the use of REBOA to treat trauma patients:

‘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 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 stabilising and preventing blood loss.’

Clinical staff from LAA worked closely with The Royal London Hospital, developing the skills necessary to perform REBOA safely in A&E, before transferring their knowledge to the pre-hospital setting.

Professor Karim Brohi, consultant vascular and trauma surgeon at Barts Health NHS Trust, commented on the partnership between LAA and The Royal London Hospital:

‘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. The Royal London Hospital Major Trauma Centre and London’s Air Ambulance have together led the way in developing new strategies and treatments to reduce this death toll.

‘While it sounds relatively simple it is an extremely difficult technology to deliver in the emergency department in hospital, never mind at the roadside. This successful deployment of REBOA represents nearly two years of development work by our staff. 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.’

Mayor of London, Boris Johnson, said:

‘London’s Air Ambulance delivers a world-class service for a world-class city. It’s astonishing to see how these stunning advances in medical care are helping people survive serious injury in London, injury that they probably wouldn’t survive elsewhere in the world. That change is being pioneered and delivered by an incredible group of men and women—the doctors, paramedics, pilots and support staff of the London Air Ambulance.’

Taken from Journal of Paramedic Practice, published 23 June 2014.