REBOA in Bleeding and Cardiac Arrest in Pre-Hospital Care by Helicopter Emergency Medical Service: The RIBCAP-HEMS Project

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) plays an important role in the mostsevere trauma and medical patients with cardiac arrest. Its use in pre-hospital emergency medicine in Germany doesnot yet regularly occur, and the vast majority of rapid response vehicles are not equipped with REBOA devices. In thisarticle we will describe the introduction of REBOA for bleeding patients, as well as an adjunct for refractory out-of-hospitalcardiac arrest (OHCA), in a German helicopter emergency medical service (HEMS).Methods: The DRF-Luftrettung HEMS base in Halle (Saale) Germany has incorporated REBOA in pre-hospital emergencymedicine and will accompany this introduction with a feasibility study. We will describe the implementationof REBOA and the results of the training course. The training consists of theoretical and practical issues within differentcase scenarios. This was carried out before introducing REBOA into pre-hospital emergency medicine. Using a preand post-course exam and a self-assessment questionnaire the theoretical and practical knowledge and the performanceof the critical care teams were determined.Results: The results of the pre-course exam in comparison with the post-course exam improved from 82% to 96%. Basedon the self-assessment questionnaires, all participants felt a relevant improvement of their theoretical and practical knowledge.All physicians successfully performed REBOA under ongoing cardiopulmonary resuscitation in manikin simulators.Conclusions: The results from the training course indicate that there was a significant improvement of the theoreticaland practical knowledge, as well as the performance of REBOA. The on-going feasibility study will show if it is worthintroducing REBOA in a civilian HEMS for the patients in extremis.

Consensus on resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian (pre-hospital) trauma care: a Delphi study

“…Brede et al 29 developed a REBOA simulation training program for HEMS-teams resulting in median procedure times of 8.5 minutes and high objective competency scores. Similarly, Hilbert-Carius et al 30 described a HEMS REBOA training course resulting in higher objective scores and self-perceived knowledge and skill improvement. Borger van der Burg et al 31,32 showed that training sessions for obtaining femoral artery access and REBOA placement, combining theory with simulation and live models, are effective in training ultrasound and endovascular inexperienced (military) (para-)medical personnel with higher training levels significantly reducing procedure times.…”

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) im prähospitalen Einsatz – Präsentation zweier Fälle

“…Vor dem Hintergrund potenziell positiver Effekte der endovaskulären Aortenokklusion bei Blutungen und im Rahmen des Out of Hospital Cardiac Arrest (OHCA) wird REBOA als optionale Therapiemaßnahme auf den Luftrettungsmitteln Christoph (CHX) 84 und CHX 85 der DRF Luftrettungsstation Halle vorgehalten. In dieser Arbeit sollen kurz die ersten Patienten, die in das REBOA In Bleeding and Cardiac Arrest in the Pre-hospital care by Helicopter Emergency Medical Service (RIBCAP-HEMS)-Projekt eingeschlossen wurden, dargestellt werden [18,19]. keine messbare Sauerstoffsättigung (SpO 2 ).…”