An emergency treatment that could save the lives of car crash victims and others with life-threatening bleeding injuries is to be trialled as part of a new £1.1m study by the University of Aberdeen.
The technique which involves temporarily stopping the blood flow to the lower part of the body until patients can be taken to an operating theatre is to be used at a number of major trauma centres during the trial.
The REBOA technique will be used only on patients with uncontrolled, life-threatening bleeding from injuries to the torso.
This type of injury, often seen in car crash victims or people who have fallen from height, is the most common cause of preventable death in trauma patients.
Whilst a limb can be compressed to reduce blood loss, severe bleeding in the abdomen or chest usually requires an operation to stop it. As a result people with such injuries can bleed to death before they reach an operating theatre.
REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) works by inserting a balloon device, through the femoral artery in the groin, into the body’s main artery.
Once above the location of the injury, the balloon is inflated, blocking the artery and stopping the blood flow to the injured parts of the body but, crucially, maintaining it around vital organs – the heart and the brain.
The procedure allows an Emergency department’s Trauma Team more time to prepare the patient for surgery.
The trial will compare the survival of those who receive REBOA and those who do not in order to establish whether it is an effective intervention.
The trial will take place across 10 major trauma centres in England over four years. The team estimate around 120 patients may be treated using REBOA during the course of the study.
REBOA is already used in trauma centres in the USA, Japan and parts of Europe but so far in the UK only the Royal London Hospital and the London Air Ambulance have used the technology.
“REBOA is quite a simple concept which many in the medical profession believe will be a tool that helps save more lives. This trial will provide evidence that either supports or refutes that conception,” explains Jan Jansen, a consultant in general surgery and intensive care medicine and honorary senior clinical lecturer at the University of Aberdeen, and the chief investigator of the study.
Mr Jansen adds: “The technology is not without its complications. Cutting off blood from half the body can only be done for so long and you have to deal with the consequences of that but with injuries this severe it can be a trade-off worth making. We want to find out if it is worth taking an extra few minutes to do this procedure and arrive in the theatre in a more controlled state.
“It’s important to stress that this procedure is only used in extreme cases where there is a real chance of the patient dying in the emergency department.
“All teams involved will be given bespoke training and as well as assessing the success of REBOA we will be evaluating how practical it is to incorporate into the procedures of each individual trauma team.
“Some early adopter teams have already started using this but this trial will provide some thorough research that shows just how effective it is at saving lives.”
The study is supported by a £1.1m grant from the National Institute of Health Research health technology assessment board and begins on April 1.
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