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Editorial
Battlefield REBOA: Aces High or Journey’s End?
  1. Paul Parker1,2,
  2. A M Johnston3,
  3. A Mountain4 and
  4. H Pynn5
  1. 1 Senior Lecturer in Special Operations Medicine, University College, Cork, Ireland
  2. 2 Orthopaedic Department, Queen Elizabeth Hospital, Birmingham, UK
  3. 3 Defence Consultant Adviser in Intensive Care Medicine, Department of Anaesthesia and Intensive Care Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  4. 4 Defence Consultant Adviser in Trauma and Orthopaedics, Royal Centre for Defence Medicine, Queen Elizabeth Hospital, Birmingham, UK
  5. 5 Defence Consultant Adviser in Pre-Hospital Emergency Care, Emergency Department, Bristol Royal Infirmary, Bristol, UK
  1. Correspondence to Paul Parker, Orthopaedic Department, Queen Elizabeth Hospital, Birmingham B15 2WB, UK; parker_paul{at}hotmail.com

http://dx.doi.org/10.1136/bmjmilitary-2021-002054

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    Non-compressible torso haemorrhage has always been a devastating and lethal injury. If the injured axial vessel has an anatomical name, death is almost certain within a few minutes. From 2003 to 2008, of 1203 injured UK service personnel, 110 had sustained injuries to named vessels; 66 of them died before any surgical intervention. All 25 patients who sustained an injury to a named vessel in the abdomen or thorax died; 24 did not survive to undergo surgery and 1 patient in extremis underwent a thoracotomy, but died. Six of 17 patients with cervical vascular injuries survived to surgical intervention; two died after surgery. In 76 patients with extremity vascular injuries, 37 survived to surgery with one postoperative death. Interventions on 38 limbs included 19 damage control procedures (15 primary amputations, 4 vessel ligations) and 19 definitive limb revascularisation procedures (11 interposition vein grafts, 8 direct repairs), four of which failed necessitating three amputations.1

    Another UK study, looking at the decade between 2002 and 2012, identified 296 patients with non-compressible torso haemorrhage demonstrating a mortality of 85.5%.2 The majority of deaths occurred before hospital admission (n=222, 75.0%). Of patients who survived to hospital, survivors (n=43, 14.5%) had a higher median systolic BP (108 vs 89, p=0.123) and GCS (14 vs 3, p<0.001) compared with in-hospital deaths (n=31, 10.5%). Haemorrhage was the more common cause of death (60%), followed by central nervous system disruption (30.8%), total body disruption (5.1%) and multiple organ failure (4.0%). On multivariate analysis, major arterial and pulmonary hilar injury were the most lethal with ORs (95% CI) of 16.44 (5.50 to 49.11) and 9.61 (1.06 to 87.00), respectively.

    In terms of surgical interventions, little has changed in two decades.3 A 2018 review of two prospectively maintained trauma databases: the UK Joint Theatre Trauma Registry for …

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    Footnotes

    • Twitter @armycritcare

    • Contributors PP conceived and collated the editorial. AMJ, AM and HP all contributed to the intellectual content. PP acts as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.