16 Jun 2014

London's Air Ambulance Charity's trauma team have performed the world’s first roadside balloon surgery to control internal bleeding.

Use of pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), a technique used first in the UK at The Royal London Hospital, to control haemorrhage in trauma patients is a ground-breaking move by London’s Air Ambulance.

After two years of development with The Royal London Hospital, this pioneering new technique will be used to prevent trauma patients bleeding to death. This technique can help control severe pelvic haemorrhage, which is an injury most commonly associated with cycling incidents and falls from height.

Commenting on the use of REBOA to treat trauma patients, Dr Gareth Davies, Medical Director for London’s Air Ambulance, said: “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.”  

REBOA works by controlling or preventing further blood loss. Blood carries oxygen which is delivered to major organs including the heart and the brain. Starved of blood, our organs stop working effectively and can become permanently damaged. The balloon is fed into the bottom end of the aorta, the largest blood vessel in the body, and then inflated, temporarily cutting off blood supply to damaged blood vessels. The patient is then transported rapidly to hospital to undergo further vital interventions.

London’s Air Ambulance worked closely with The Royal London Hospital to deliver REBOA safely in A&E, before embarking on the surgery outside of hospital. 

Speaking about this partnership, Professor Karim Brohi, Consultant Vascular and Trauma Surgeon at Barts Health NHS Trust said: “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.”

Having treated over 30,000 people in the capital, London’s Air Ambulance has an international reputation for pioneering medical procedures which have been adopted across the world. London’s Air Ambulance pioneered thoracotomy (open heart surgery) at the roadside and in 1993 produced one of the world’s first survivors from this procedure. 

Dr Gareth Davies continued: “We have always provided highly trained, expert teams to care for injured Londoners and today we are pleased to further improve our service by adding this innovation. As a charity, it is only through the support of the community we serve, that we can save lives of seriously injured people in London.”

The 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.”

REBOA illustration supplied by the BBC. Watch online a demonstration by Dr Gareth Davies.

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