Field and en route REBOA: A feasible military reality?.

BACKGROUND: Severe non-compressible torso hemorrhage (NCTH) remains a leading cause of potentially preventable death in modern military conflicts. Resuscitative endovascular occlusion of the aorta (REBOA) has demonstrated potential as an effective adjunct to the treatment of NCTH in the civilian early hospital and even pre-hospital settings - but the application of this technology for military pre-hospital use has not been well described. We aimed to assess the feasibility of both field and en route pre-hospital REBOA in the military exercise setting simulating a modern armed conflict. METHODS: Two adult male Sus Scrofa underwent simulated junctional combat injury in the context of a planned military training exercise. Both underwent zone I REBOA in conjunction with standard tactical combat casualty care (TCCC) interventions - one during point of injury care and the other during en route flight care. Animals were sequentially evacuated to two separate Forward Surgical Teams (FSTs) by rotary wing platform where the balloon position was confirmed by chest X-Ray. Animals then underwent different damage control thoracic and abdominal procedures before euthanasia. RESULTS: The first swine underwent immediate successful REBOA at the point of injury 7:30 minutes after the injury. It required 6 minutes total from initiation of procedure to effective aortic occlusion. Total occlusion time was 60 minutes. In the second animal, the REBOA placement procedure was initiated immediately after take-off (17:40 minutes after the injury). Although the movements and vibration of flight were not significant impediments, we only succeeded to put a 6-Fr sheath into a femoral artery during the 14 minutes flight due to lighting and visualization challenges. After the sheath had been upsized in the FST, the REBOA catheter was primarily placed in zone I followed by its replacement to zone III. Both animals survived to study completion and the termination of training. No complications were observed in either animal. CONCLUSION: Our study demonstrates the potential feasibility of REBOA for use during tactical field and en route (flight) care of combat casualties. Further study is needed to determine the optimal training and utilization protocols required to facilitate the effective incorporation of REBOA into military pre-hospital care capabilities. (C) 2017 Lippincott Williams & Wilkins, Inc.

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