Vancouver General Hospital is the first in western Canada to deploy a new balloon-tipped catheter device to save the “sickest of the sick” patients who are at risk of bleeding to death following car accidents, stabbings and other injuries such as gunshot wounds.
In the past few months, trauma teams at the hospital have been practising on cadavers and simulation mannequins, but they recently used the REBOA (resuscitative endovascular balloon occlusion of the aorta) on a gunshot victim. He was in hemorrhagic shock after sustaining multiple wounds to the abdomen — and he survived.
Doctors say up to 90 per cent of patients in hemorrhagic shock can die after a thoracotomy — the conventional method of opening the chest to clamp the main aorta artery. But the REBOA device and procedure is less invasive and may help save more lives. Doctors expect it will be used on up to 15 trauma patients a year at VGH.
The technique for stabilizing patients in shock and in danger of bleeding to death from traumatic injuries to the chest (below the diaphragm), abdomen or pelvis works by controlling or stopping the hemorrhaging. In the trauma bay area of the emergency department, trauma specialists thread a balloon-tipped catheter up to the aorta, entering through the femoral artery in the groin. The balloon is placed inside the aorta, then filled with saline to temporarily block it off to stop further hemorrhaging.
The device stops bleeding in the lower half of the body, but maintains blood circulation to the brain, heart and lungs. Once the balloon is inflated, a patient’s dire low blood pressure should normalize.
The device is not unlike the flexible balloon-tipped tubes that are used in angioplasty procedures by interventional cardiologists to open up blocked coronary arteries. But in this case, the balloon is used to close up the artery. It is ideally suited to patients whose bleeding cannot be controlled through compression techniques because of their extensive injuries.
The REBOA is a stop-gap measure. Once the balloon has been inserted, medical teams have just under an hour to get patients onto the operating room table for surgery to repair the injuries to vital organs that are the source of the bleeding.
The disposable REBOA device costs about $2,000 and VGH doctors are upbeat about its potential.
“This new device will allow us to gain precious minutes in the patient’s golden hour during which controlling the hemorrhage is the single most important move to improve survival,” said trauma surgeon Dr. Emilie Joos, the first surgeon to use the REBOA procedure at VGH, and as it turns out, the first in Western Canada.
“For me, the decision was simple: either I would inflate this balloon in the patient’s aorta or he would die on the OR table,” said Joos. “REBOA allowed me to find and control bleeding from multiple injuries.”
Previously, trauma surgeons would have to make a large incision from the patient’s chest to pelvis and use a clamp to temporarily stop the bleeding, said Dr. Naisan Garraway, medical director of the VGH trauma program and a former Canadian Armed Forces doctor. He has done multiple tours of duty in Afghanistan and Iraq and said earlier versions of a REBOA-like device were used on battlefields to stabilize soldiers so they could be airlifted.
“Implementing REBOA will help us continue to be on the leading edge of care for the trauma patient,” he said.
The device got Health Canada approval last year. Trauma doctors in Montreal were the first to use it.