Professor Thomas Colletti
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for the non-surgeon has been discussed as a stop-gap in the pre-hospital management of a hemodynamically unstable patient until suitable surgical intervention is available. The discussion's key argument for non-clinicians to perform this invasive procedure is that if nothing is done, the patient will die. This view may work for a single patient with a robust medical evacuation system and a team of knowledgeable assistants. However, rapid TRIAGE is fundamental in a mass casualty event (MASCAL). The least seriously wounded may be the first to receive treatment priority since returning casualties to duty in a far-forward environment is paramount in the military or first responder setting.
Additionally, exhausting all efforts on one patient may result in the death of many more due to the finite amount of supplies and time available. Considering these factors, REBOA may not currently have a role for the far-forward medic due to only delaying death for 30-60 minutes without proper surgical intervention. However, further research into partial and intermittent occlusion, artificial intelligence-assisted portable ultrasound, telemedicine, and unmanned aerial evacuation platforms is necessary to make pre-hospital REBOA as commonplace as the tourniquet has become.
Hamilton DJ. Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Non-compressible Torso Hemorrhage. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2023; 5(1).
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