Battlefield Invention to Stop Blood Loss Could Save Lives in Civilian Trauma Cases

ERs slowly adopt balloon-tipped catheter

After last month’s terrorist attack in Times Square, doctors and nurses at NYC Health & Hospitals/Bellevue raced to save a high school senior who had sustained serious injuries to her legs, abdomen, and pelvis. The girl was hemorrhaging internally, and transfusions couldn’t keep up with the blood loss. She was about to go into cardiac arrest.

Dr. Marko Bukur, a trauma surgeon, grabbed a device that neither he nor anyone else at the hospital had ever used, except in training sessions on mannequins. It had arrived at Bellevue just days before.

The device, called an ER-REBOA catheter, was created on the battlefields of Iraq and Afghanistan, the brainchild of two military doctors who saw soldiers die from internal bleeding that medical teams in small field hospitals couldn’t stop. REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta.

The invention, cleared by the FDA in 2015 and manufactured by Prytime Medical, is gradually being adopted in civilian trauma centers, according to an article in the New York Times. But medical teams need rigorous training to use it: Mishandled, it can be dangerous. Several patients in Japan had to have legs amputated after being treated with a related device that was left inflated for too long.

In the case of the injured high school girl, a slim tube was threaded into her femoral artery and eased up about 12 inches into her aorta. Then salt water was injected to inflate a balloon near the tip of the tube, blocking the aorta and cutting off circulation to the patient’s pelvis and legs. Above the balloon, blood still flowed normally to her brain, heart, lungs, and other vital organs.

But the clock was ticking. Circulation could be safely cut off for no more than about 30 minutes. Beyond that, the lack of blood flow could severely damage the patient’s legs and internal organs.

The idea for the ER- REBOA device came to Drs. Todd E. Rasmussen and Jonathan L. Eliason in 2006, while they were deployed as surgeons in Iraq. Improved tourniquets and transfusion techniques prevented soldiers from bleeding to death from wounds in their arms and legs, but there was no similar solution for bleeding in the abdomen or pelvis, or what doctors call “noncompressible hemorrhage.”

Rasmussen and Eliason, both vascular surgeons, started to develop a new device based on an older balloon catheter designed to prevent bleeding in patients undergoing surgery on the aorta. By 2009, they had made a prototype.

Today, the catheters, used once and then thrown away, cost about $2,000 each, which is relatively cheap compared with other devices used in vascular surgery, according to the Times article. The Defense Department and the University of Michigan hold the patent.

Source: The New York Times; June 19, 2017.