Wartime innovation: Battleborn medical device saves lives at home Published March 29, 2016 By Senior Airman Amber Carter 60th Air Mobility Wing Public Affairs TRAVIS AIR FORCE BASE, Calif. -- In the early morning hours of Feb. 21, a 28-year-old gunshot victim is inside an ambulance enroute to University of California Davis Medical Center, the only level I trauma center in Sacramento, California. The patient, receiving cardiopulmonary resuscitation during transport, is fading quickly due to blood loss from multiple gunshot wounds. After a quick evaluation in the emergency department upon arrival, doctors determined that the wounded man needed an operation immediately if he was going to survive. In the operating room, Air Force Lt. Col. (Dr.) Joseph DuBose, 60th Surgical Operations Squadron vascular and trauma surgeon, noticed how quickly the victim was deteriorating and determined the victim was not going to survive long enough for the life-saving operation to begin. "We needed to buy some time," DuBose said. "We had to restore blood flow to his critical organs so that we could conduct the operation he needed to survive. At that point in time with what we had available, we were still trying to muster the tools needed to operate on him. The REBOA was not just an answer, it was the only answer that was capable of saving his life." Medical breakthrough The Food and Drug Administration approved the REBOA catheter, or resuscitative endovascular balloon occlusion of the aorta, in January 2016. The REBOA catheter is a device that is inserted into a hemorrhaging vessel and stops or slows the blood flow to that injury while allowing blood flow to continue to vital organs and other body parts. The idea originated at the 59th Medical Wing at Lackland Air Force Base, Texas, the main hub for autopsies performed on combat casualties. "The autopsies showed that the No. 1 cause of potentially survivable deaths by service members is non-compressible hemorrhaging in the chest and core," said Air Force Maj. Lucas Neff, 60th SGCS vascular surgeon. "We have worked on techniques [with the REBOA] that allow us to control the amount of blood flow that can pass while using the catheter. It's like a faucet where you can turn the flow down in areas where there is bleeding without turning it completely off, allowing blood to flow to other important areas." The creation of the catheter itself was part of a joint collaboration of both medical and non-medical professionals. Building a new device from the ground up took a team effort including assistance from Travis civil engineer and maintenance personnel, who built the machinery and components necessary to craft the device. "It went from a spark of an idea in an Airman's mind to being used to save a life in about five years, which, in terms of device and innovation, is like hyperdrive," Neff said. "That shows that the confluence of having a very significant need and having the right people driving the bus can lead to a solution." Researchers developed the REBOA after identifying a need for a device that can slow bleeding, without damaging vital organs, long enough for the patient to receive the life-saving care that is needed. "I am very proud to have been a part of the innovation that led up to this moment and for the opportunity to put the hard work of diligent Air Force researchers into clinical use," he continued. "I have no doubt REBOA is a game changer in the civilian trauma world and in the battlefield." DuBose credits his team at the Clinical Investigation Facility, Travis Air Force Base, as a crucial part of research and development of the REBOA catheter. "I first learned about REBOA as a young trauma surgeon at Wilford Hall Medical Center in 2009," DuBose said. "I cannot take credit for being a key pioneer in the translational research in the Air Force that led to where REBOA is now, but I have been privileged to have been affiliated with both the lab at Wilford Hall, where the work began, and now with Maj. Williams, Maj. Neff and the rest of the team at the CIF at Travis, where that work is being moved forward more effectively than anywhere in the world." Clinical Investigation Facility The CIF, located at David Grant USAF Medical Center, is one of seven Air Force medical facilities with formal clinical investigation programs and resources. "The function of the CIF is education and training, first and foremost, of our medical staff, residents, and upcoming trauma and general surgeons," said Air Force Maj. Timothy Williams, 60th SGCS vascular surgeon. "This project and the lines of research that have evolved out of it have been very productive for our residents." While deployed together to Afghanistan in 2014, Williams and Neff discussed catheters and the benefit of furthering the research of their capabilities. "I don't know if I would've gone down this road of research if it wasn't for that deployment," Williams said. "Having actually been there and seen the casualties firsthand brought me to this research." DuBose credits his Air Force training and experience with allowing his patient to survive his injuries on Feb. 21 and walk out of the hospital a couple days later. "Air Force research conducted at the CIF directly contributed to saving the life of this 28-year-old father of six," he said. "I have done trauma surgery all of my professional life, including work at three civilian level I trauma centers and three deployments. I can, without reservation, state that REBOA saved his life."