Techniques and Technology in Medicine

"[It -- a balloon catheter -- was] really designed to be used in nice surgery centers, with well-staffed, fancy operating rooms."
"[The] golden hour [following an injury is the time when doctors and medics must react]. That's where the margin to save lives is greatest."
Dr. Todd E. Rasmussen, former surgeon deployed in Iraq

"None of that [conventional hospital procedure where the balloon catheter is used by vascular surgeons] translates well into when all hell is breaking loose [in a war zone] and your patient is going to die in seven minutes."
David Spencer, president, Prytime Medical, ER-Reboa manufacturer

ER-REBOA Catheter for Emergency Occlusion of Aorta

Necessity, those steeped in the wisdom of the ages intone, is the mother of invention. And when Drs. Todd E. Rasmussen and Jonathan L. Eliason were desperate to save the lives of U.S. military members fighting in Iraq in 2006, they had the use of improved tourniquets and transfusion techniques to prevent their military patients from bleeding to death from catastrophic limb wounds as byproducts of battlefield action.

However, those advanced techniques did nothing whatever to help in emergencies like extreme bleeding in the abdomen or the pelvic area. They were vascular surgeons, and began work on the development of a new device to fill that obvious gap. Using the old device of a surgical-room balloon catheter as a guide, one whose design was specific to bleeding prevention in patients undergoing surgery on the aorta, they perfected their own device which they named the ER-Reboa.

It is now being used in some hospitals, gaining ground as its reputation is on the rise as a more reliable medical tool  than the older, larger, device requiring to be guided by X-rays. At NYC Health & Hospitals/Jacobi in New York City, director of Trauma and Critical Care Services Dr. Sheldon H. Teperman and vascular surgeon Dr. Aksim G. Rivera have been tutoring trauma surgeons in the use of this new device.

A woman, 60 years of age, had been hit and run over by a pickup truck, sustaining internal injuries so dire she almost died from internal hemorrhaging resulting from severe pelvic injuries. She was the first patient in the city that the new device was used for, by a Jacobi team. And her life was spared. In May, a high school student suffering internal hemorrhaging as a victim of a deliberate vehicle mow-down by a terrorist in Times Square, recovered thanks to the device, when transfusions failed to restore the equilibrium of blood loss.

The student had emerged from the attack with severe injuries to her legs, abdomen and pelvis. Her pulse skyrocketed, her blood pressure plunged. "She was about to go into cardiac arrest", noted trauma surgeon Dr. Marko Bukur. He immediately reached for an ER-Reboa catheter, punctured the student's thigh to thread a slim tube through her femoral artery then on to her aorta, the major artery carrying blood from heart to body. Injecting salt water, a balloon was inflated to block the aorta, cutting off circulation to pelvis and legs.

While above the balloon, blood flowed as it normally would to her brain, her heart, lungs and other organs. Reactively, her blood pressure rose, her heart showed down as the balloon halted the internal pelvic hemorrhaging. The resuscitative endovascular balloon occlusion of the aorta (Reboa) had done its work as it was meant to, as an "internal tourniquet". Dr. Bukur packed the damage area with gauze once the balloon was deflated, while another surgeon removed the student's ruptured spleen, her life saved.

The two former military surgeons had succeeded in creating a smaller, stripped-down version of the complex, large and awkward-to-use outside a well-equipped hospital operating theatre, one that could be manoeuvred swiftly into the aorta without the use of guiding X-rays, by general surgeons, emergency room doctors and even medics, since the last two represent those who are generally the first responders reaching people who are bleeding to death.