Clinical innovations

Red cell and plasma trial

In collaboration with London’s Air Ambulance clinical teams, the transfusion team at The Royal London Hospital has conducted a feasibility study delivering combined red cell and plasma (RC&Plasma) components to patients at risk of death from bleeding. The trial, kindly supported by The Saracens Foundation and The Henry Surtees Foundation, finishes in October 2020 – project results are eagerly awaited and may lead to a large-scale national trial involving other UK Air Ambulances.

ECMO and Sub 30 trial

We have been supporting Barts Health NHS Trust in an ECMO (Extracorporeal membrane oxygenation) and Sub 30 trial. This trial assesses the feasibility of developing pre-hospital ECMO within 30 minutes of a call to the emergency services, for selected patients suffering out-of-hospital cardiac arrest in London. The trial started during the 2019/20 financial year but was brought to a halt, due to the COVID-19 pandemic in March. The trial now has approval in principle to restart.

GoodSam

We are making good progress with work to digitise many of our routine processes on the helipad, so that we can free up our medical teams for training and development. In 2019, we began a new operational digital strategy to support frontline clinicians. This provided an exceptional quality of pre-hospital trauma by sharing patient data electronically and supporting improved integration with London Ambulance Service NHS Trust, Barts Health NHS Trust and London Major Trauma Network, to support patients from injury to recovery.

The first step in late 2019 was to work with LAS to implement a video link, using the GoodSam App, from the despatch desk at LAS Emergency Operating Centre (EOC) in Waterloo, to allow our paramedic direct video access (with appropriate permissions) to any smart phone that had called the EOC. This not only allows prompt advice to be given, but also ensures that the right assets are despatched to the scene more quickly.

Looking ahead: Zone 1 REBOA

REBOA stands for Resuscitative Endovascular Balloon Occlusion of the Aorta. It is a procedure that involves placement of an endovascular balloon in the aorta – this acts like a tourniquet, but inside the body to control bleeding.

London’s Air Ambulance has been carrying out this procedure in ‘Zone 3’ above the pelvis, since 2012. In May 2020, we started a clinical trial of Zone 1 REBOA – this is the use of REBOA in the area above the diaphragm. The ability to block blood flow higher up in the body means we can potentially use this intervention in a wider group of patients with bleeding anywhere below the diaphragm as opposed to only within the pelvis, but this is accompanied by greater risks and requires a more complex procedure to mitigate the risks. This is the first time REBOA Zone 1 has ever been used outside of the hospital setting worldwide, in a study to evaluate its effectiveness.