In-flight resuscitative endovascular balloon occlusion of the aorta (REBOA): Testing the limits of endovascular care in hHelicopter emergency medical services.

BACKGROUND

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is increasingly used to control non-compressible torso hemorrhage in advanced trauma systems. However, its feasibility during active helicopter transport remains unclear. This study evaluated whether trained Helicopter Emergency Medical Services (HEMS) teams can perform REBOA in flight under realistic conditions.

METHODS

A prospective high-fidelity simulation study was conducted with fourteen HEMS clinicians organized into seven physician-nurse teams. Standardized hemorrhagic shock scenarios were performed in full-motion helicopter simulators replicating AW109 and Bell 412 cabins. The primary outcome was successful in-flight REBOA deployment. Secondary outcomes included time to balloon inflation, first-attempt success, and procedural performance using the Objective Structured Assessment of Prehospital REBOA Application (OSAPRA).

RESULTS

Successful deployment was achieved in all simulations (100%). Median time to balloon inflation was 7:32 min. First-attempt success occurred in 78.6% of cases. Higher OSAPRA scores were associated with shorter procedural times. Inflation times were shorter in the AW109 compared to the Bell 412, although overall success was similar.

CONCLUSIONS

In-flight REBOA deployment is technically feasible in high-fidelity simulation. Operator competence and cabin configuration may influence performance, supporting further research prior to clinical implementation.