Emory and Morehouse Surgeons Establish REBOA at Grady
The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in trauma centers has been growing over the past several years, though the specialized training required to learn how to perform the procedure is not uniformly available.
"As the only nationally verified Level 1 trauma center in Metro Atlanta, we must be leaders in research and continually pursue innovative ways to treat our patients," says Bryan Morse, MD, MS, an Emory University surgeon-researcher-educator in the trauma/surgical critical service at Grady Memorial Hospital and director of trauma research at the facility. "REBOA is a perfect example of the type of modern trauma technology and technique that should be practiced, evaluated, and taught at Grady."
Intended as a temporary measure to sustain heavily bleeding patients before they can get to the operating room, REBOA is a minimally invasive technique that involves placing a catheter into the femoral artery, maneuvering it to the aorta, and inflating a balloon at its tip to stop bleeding.
In November 2016, K. Aviva Bashan, MD, a Morehouse School of Medicine surgeon on the trauma service and former Emory general surgery resident, was on-call when a patient who suffered traumatic injuries from a motorcycle accident was brought to Grady. Dr. Bashan, alongside Dr. Morse and Jonathan Nguyen, DO, another Morehouse faculty surgeon based at Grady's trauma center, performed the first REBOA procedure in the state of Georgia on the patient.
To contribute further to establishing REBOA's utility, Dr. Morse became the primary site investigator at Grady for a multicenter, Department of Defense-funded observational study that is collecting detailed prospective information on the use of the Prytime ER-REBOA™ Catheter and other emergent truncal hemorrhage control interventions such as open thoracotomy and laparotomy, and then analyzing and comparing the types of outcomes and complications associated with each approach.
Following the combined efforts of Dr. Morse, Dr. Bashan, and Dr. Nguyen, the hospital also became the first in Georgia to offer an endovascular surgical skills course focused on teaching REBOA to other surgeons across the country. Called Grady Rescue and Endovascular Approaches to Trauma (GREAT), the six-hour course comprises didactic material and simulation training using the latest catheter technology to demonstrate technical aspects of the procedure on mannequins and cadavers.
"We conducted the first GREAT course in December 2017 with eight Emory and Morehouse schools of medicine fellows, who are now trained to perform the procedure at Grady," Dr. Morse says. "We built this course from the ground up, and as a teaching hospital, it's exciting to see how far it will go."
"I hope other hospitals, especially those in Georgia, will choose the Grady GREAT course to learn this technique," Dr. Bashan says.
Dr. Nguyen confirms that GREAT's next session is scheduled for later this spring, and has potential to attract physicians from other countries.
"We're one of the busiest trauma centers in the country, we have some of the smartest and most talented trauma surgeons here, so if anyone is going to lead in figuring out REBOA's niche and teaching others, it's going to be Grady," he says.