Prehospital Hemorrhage Control and REBOA
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Purpose of Review
Review the current state of the art in prehospital hemorrhage control and the role of resuscitative endovascular balloon occlusion of the aorta (REBOA).
Prehospital data demonstrate improved hemorrhage control and decreased blood product transfusions with tourniquet use. Minimal complications have been noted (temporary nerve palsy) and no tourniquet-related amputations have been reported in modern series. Junctional tourniquets are effective in stopping arterial flow and controlling bleeding in preclinical trials. Clinical data is lacking. Hemostatic bandages have been shown in animal studies to improve time to hemorrhage control and survival. Limited clinical data supports improved hemorrhage control and no morbidity. The REBOA catheter is a promising technology with a clear role in severe pelvic fractures. The role of REBOA in the prehospital setting remains undefined.
Preclinical and clinical data are supportive of both prehospital tourniquet and hemostatic bandages. Junctional tourniquets are promising but lack clinical data. The REBOA catheter is an effective bleeding control adjunct for which prehospital indications are still being defined.
KeywordsPrehospital hemorrhage control Tourniquet Hemostatic agents Junctional tourniquet REBOA Prehospital trauma
Compliance with Ethical Standards
Conflict of Interest
Dr. Fox has nothing to disclose. Dr. Campion has nothing to disclose.
Human and Animal Rights and Informed Consent
All reported studies/experiments with human or animal subjects performed by the authors were performed in accordance with all applicable ethical standards including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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