How might we improve the prehospital experience for medical emergency professionals during the REBOA therapy?

Emergency Occlusion System

 

Being an emergency doctor or emergency paramedic is a tough job. In bigger cities, they deal with road accidents, shooting, stabbings and falls from heights on a daily basis. Environmental distractions, bad light and weather conditions hamper the already difficult procedure to save patients from bleeding out to death at the scene.

REBOA is a “newly” discovered method to occlude the aorta with a balloon to stop internal bleeding and give the patient enough time to reach the hospital and get surgery. If used correctly, this procedure can save many lives, but can be fatal if the aorta is occluded for too long. Making the REBOA procedure more approachable and less complex could raise the number of surviving patients significantly.


Umeå Institute of Design // Master thesis // Medical design // 17 weeks // Single project // Mentored by Foundation 5 and Dr. Samy Sadek from London Air Ambulance // Collaboration with Foundation 5 and London Air Ambulance
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What does REBOA mean?

Resuscitative Endovascular Balloon Occlusion of the Aorta

Treating a patient pre-hospital with non-compressible torso hemorrhage can be problematic, due to the current therapies which require to open the chest of the patient. REBOA is a re-invented tool from the Korean war, which is able to stabilize the patient in shock by occluding the blood flow temporarily. It is a proactive approach in the pre-hospital context and requires specific training and an experienced team involvement.

 

“We believe the use of REBOA can lead to a reduction in the number of patients who quite simply bleed to death before they have the chance to get to hospital where there are highly developed systems for stabilising and preventing blood loss.” (Dr. Gareth Davies, London Air Ambulance)

 
THORACOTOMY In case patient's are bleeding out internally and has lost the vital signs, thoracotomy is used to stop the bleeding by clamping the aorta. To achieve this, the doctor has to open up the chest to be able to access the aorta. This invasive method only shows a 9-12% survival rate, as most patients cannot recovery after this injury.

THORACOTOMY

In case patient's are bleeding out internally and has lost the vital signs, thoracotomy is used to stop the bleeding by clamping the aorta. To achieve this, the doctor has to open up the chest to be able to access the aorta. This invasive method only shows a 9-12% survival rate, as most patients cannot recovery after this injury.

REBOA This method requires a balloon catheter inside the femoral artery which is pushed up into the artery. In the right position the balloon gets occluded to clog the blow flow and be able to give blood back to the heart. This results in the patient getting back his vital signs and having more time to get to hospital.

REBOA

This method requires a balloon catheter inside the femoral artery which is pushed up into the artery. In the right position the balloon gets occluded to clog the blow flow and be able to give blood back to the heart. This results in the patient getting back his vital signs and having more time to get to hospital.

 

Learning from experts

Tour with Dr. Stöbich, Eferding Ambulance, Austria

Tour with Dr. Stöbich, Eferding Ambulance, Austria

Joining emergency shift with Umeå Ambulance, Sweden

Joining emergency shift with Umeå Ambulance, Sweden

Visiting Hazardous Area Response Team London, UK

Visiting Hazardous Area Response Team London, UK

 
“I have always been really cautious when cycling. You have got buses overtaking you, and taxis, but I have never felt that this would happen to me."  - Victoria Lebrec, 24

“I have always been really cautious when cycling. You have got buses overtaking you, and taxis, but I have never felt that this would happen to me."  - Victoria Lebrec, 24

MEETING VICTORIA, A REBOA SURVIVOR

Victoria was cycling to work when she was crushed by a skip lorry and suffered near-fatal injuries. After the accident Victoria was conscious, but her pelvis, lower abdomen and thigh had been crushed causing her to lose large amounts of blood, and putting her at risk of cardiac arrest.  
Victoria only survived because of the REBOA procedure performed by Dr. Sadek and paramedics Bill Leaning from the London’s Air Ambulance at the roadside. This was the second time - worldwide - that REBOA had been performed in prehospital. With the REBOA balloon, Dr Sadek was able to stem the hemorrhage from her crushed pelvis and prevent cardiac arrest. 

 

Pre-hospital set up

 

Occlusion time of the balloon

 

Equipment

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My design opportunity

 

The design process

 

The result

 

With automated inflation of each balloon in the upper and lower body, EOS simplifies the procedure complexity for emergency professionals and reduces the stress at the scene. EOS is a system which comes in a layered packaging. On top is the "Preparation kit" which you need to access the aorta. Underneath is the "Occlusion kit" which inclused the device attached to the balloon catheter.

 
 
 

1. Preparation kit

PREPARING FOR THE REBOA CATHETER

To start the procedure, the doctor inserts the entry sheath with the help of an ultrasound, to see, if he punctuates the femoral artery. If this step was successful, the doctor pushes the sheath (white) further into the skin. At the same time he pulls out the dilator (green). The purpose of the dilator is to punctuate the skin / femoral artery and to provide an easy access for the sheath, which is the introducer for the balloon catheter. 

 

2. Occlusion kit

 

INTERACTION

It is pretty simple. In the beginning you have to pull out the strip to activate the device. Then it asks you to choose a balloon, you want to inflate. Afterwards, you simply press + to inflate and wait until the timer goes on - this is a sign that the balloon has been inflated. 

 

With the help of optical pressure sensors, EOS controls the pressure in the balloon to be suitable for each individual aorta. The user can switch between the top and the bottom balloon, depending on where the injury might be. After the balloon in either zone III or zone I is occluded (inflated), the timer automatically tracks the time. When the time limit is reached, the doctor gets notified by sound and display signals.