In 2014, the air ambulance team of Lun Dun performed the world's first pre-hospital (field) resuscitation of an aortic balloon occlusion (REBOA).

At present, there is no domestic!

So you can imagine how difficult it is to do this surgery in the wild, it's skyrocketing!

Hu Dongwei doesn't think that this young doctor in front of him can be compared with the doctors of the world's top emergency team!

Even the director of the emergency department of their hospital is outside the hospital, and there is absolutely no such technique to do resuscitative aortic balloon occlusion of the abdominal aorta and intra-abdominal arteries.

However, if the thigh artery is given out-of-hospital resuscitation of the aortic balloon occlusion, it can be challenged. After all, resuscitative aortic balloon occlusion of the thigh artery is several times simpler. Find the artery directly at the upper end of the thigh artery break and insert a balloon to block it.

However, the difficulty of resuscitative aortic balloon occlusion of the abdominal aorta in the abdominal cavity is purgatory-level, and there is a blank in China at present. There is no first case yet!

The reason why it is difficult to perform this surgery outside the hospital is that it is best to perform ultrasound guidance when the femoral artery puncture and catheterization begins the operation.

The advantages are: precise localization, identification of anatomical variations in the femoral artery, and reduced risk of potential arterial injury. Ultrasound-guided puncture may also increase the success rate of first needle puncture in the setting of shock or when the femoral pulse is not palpable.

But you do this piercing outside the hospital, there is no ultrasound guidance at all, and when you pierce it, it is completely blind!

It's all about experience and luck.

BAD LUCK, GG.

In addition to this, when the balloon catheter is inserted, this part of the operation is usually performed under X-ray fluoroscopy, but there is no such equipment outside the hospital (field). You can only do this with your experience and luck.

Finally, when vascular occlusion is performed, it is best to have a chest x-ray to see the location of the blocking balloon. When inflating the balloon catheter, it is best to inflate the balloon under fluoroscopic monitoring. It is important to maintain the position of the long sheath just below the balloon to provide support and prevent the inflated balloon from being rushed downwards by the bloodstream.

The above points are all done with auxiliary equipment.

If you're in the hospital, it's easy to say anything!

But now outside the hospital, if you do this surgery, you will lose both eyes, and you will be completely operated by a blind monk!

Rely entirely on your experience, judgment, and operation to make up for the above instruments!

This is also the reason why there is no one in the country who can do this kind of surgery before the hospital (in the field)!

"Are you sure you can? Do you know that it will be a completely blind operation at that time!" Hu Dongwei felt that Ruan Bin was completely fooling around!

"Yes, if you make a mistake, it will be equivalent to giving the patient another knife, and now you may have a chance to send it to the hospital!" Lei Jincheng next to him said in a deep voice.

"The patient is our responsibility, it has nothing to do with you, you better get out of the way!"

If something goes wrong, they're responsible!

"Two doctors, let him give it a try!" At this time, when the woman saw Ruan Bin saying that she could stop the bleeding and save her life, she instantly chose to convince Ruan Bin, at least a dead horse should be a live horse doctor, isn't it?

"If there is an accident, I am responsible alone!" Ruan Bin said.

He didn't want to dwell on this issue, and now it was important to save people!

"Did you have an occlusion balloon?" asked Ruan Bin anxiously.

"Yes!" Hu Dongwei heard the other party say that he was fully responsible, and his family also agreed. He simply intends to delegate power. Because he knows very well that if the patient is sent to the hospital in this situation, he will definitely not survive the hospital!

Soon Ruan Bin got the tools and began to make surgical tools for resuscitation of aortic endovascular balloon occlusion, which was not a hospital, and the other party did not bring anything in this regard.

He can only make one temporarily!

Good thing they have the key thing - occlusion balloons!

At this time, the two doctors and nurses were shocked when they saw Ruan Bin quickly use a knife to convert a urinary catheter, a 14-gauge needle, an arterial guidewire and an occlusion balloon into surgical tools!

"Can it be like this?" Hu Dongwei was stunned.

"It's a bit rudimentary, but it shouldn't be a problem to use, give me 20 ml of saline!" Ruan Bin continued.

Get everything right and start the surgery!

There are 5 basic steps in the REBOA procedure: arterial puncture and sheath implantation, balloon catheter implantation, balloon filling, balloon relaxation, and vascular sheath extraction.

It looks simple, but it's not easy to do, because you're messing with the abdominal aorta. Let's not talk about whether you can blindly manipulate to find the abdominal aorta, and if you find it, can you successfully judge whether you have reached the bleeding point?

Picking up a knife, Ruan Bin began to make an incision at the common femoral artery location, and then took the puncture into the common femoral artery!

With world-class experience, he judged this needle very accurately, and his brain seemed to show the arterial map of the patient's whole body at this time, and could judge the position of the femoral artery, how he should use his strength, how many points, and in what direction to pierce it, and how to adjust the direction of the needle to ensure that the femoral artery is continuously punctured.

Next second!

He plunged a needle directly into the common femoral artery.

"Did you enter the common femoral artery?" asked Lei Jincheng, who was squatting next to him, nervously, his palms sweating. He felt that he was more nervous than Ruan Bin!

If the other party succeeds, it will become the first doctor in the country to do REBOA surgery before the hospital (in the field)! If it fails, the patient will say goodbye to this world completely!

"I'm judging the location of the external iliac artery. Ruan Bin said without raising his head.

"It's so accurate!" Hu Dongwei heard this, and a glimmer of hope appeared in his heart. The other party pierced the femoral artery with a needle, which is a blind stab! Now they are looking for the external iliac artery.

If this operation is done in the hospital, it needs to be pierced with ultrasound guidance, and this guy actually succeeded in blind piercing!

"However, it is a huge difficulty to find the external iliac artery in the common femoral artery!" Hu Dongwei, who had just had a glimmer of hope in his heart, began to nervous again.

Because it's still a blind exercise!

Entering one artery from one artery is like threading a needle with your eyes closed!

At this time, Ruan Bin was manipulating the arterial guidewire and slowly exploring.

The calm big hand senses the information conducted by the arterial guidewire, so as to carry out the next transmission, how deep it should be transmitted, and the direction of control.

"It should be this position!" Ruan Bin roughly judged the distance and distribution of the femoral artery blood vessels and the external iliac artery blood vessels in adults, and then looked at how long the catheter in his hand was, and combined with the many experiences in his mind, he made an accurate judgment!