Prolonged Field Care Podcast 30: REBOA For Prolonged Field Care With Joe Dubose

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.    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. REBOA   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.  For more content, visit www.prolongedfieldcare.org