When Kevin Ward, MD, first pitched his idea for a new method of aortic occlusion more than twenty years ago, the Department of Defense was less than interested. In fact, they weren’t even sure it was possible.

“War back then was different than war now. You had a completely different set of challenges. Now, two decades later, you have special operation missions in the most remote parts of the world. There are new problems, which means there’s a need for new solutions,” said Ward.

The REBOA technique utilizes the femoral artery to place the catheter and inflate the balloon in the aorta.

The REBOA technique utilizes the femoral artery to place the catheter and inflate the balloon in the aorta.

This new set of challenges has required the Department of Defense (DoD) to shift their focus towards Prolonged Field Care research. As war zones become more isolated, the DoD is projecting it could take up to 72 hours to evacuate an injured soldier, meaning it could be days until patients have access to resources such as a field hospital or a surgical unit. In short, they need treatments that will buy more time.

For patients with noncompressible, internal hemorrhaging, Dr. Ward’s new device might be the solution that gives them that time.

When a soldier is shot in the abdomen, medics can’t use a tourniquet or apply direct pressure to the injury like they would to a wounded leg, meaning it’s difficult to stop the bleeding. One method that has been successful is known as REBOA, or resuscitative endovascular balloon occlusion of the aorta. A catheter is placed in the leg and snaked up through the aorta where a balloon is inflated to block blood flow and stop the bleeding. Unfortunately, this method is invasive and requires special training not widely available in the battlefield.

“It’s not exactly easy to place a catheter in the mountains of Afghanistan or on the side of a highway,” said Ward.

Inspired by the REBOA technique, Dr. Ward developed GROA: gastroesophageal resuscitative occlusion of the aorta. As opposed to using a catheter to stop the bleeding, Ward’s device non-invasively occludes the aorta by going into the mouth, down the esophagus, and into the stomach.

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Using anatomy to his advantage, Ward’s method utilizes the stomach’s position next to the abdominal aorta. By inflating a balloon and swelling the stomach, enough pressure can be placed on the aorta to “pinch” it closed, stopping the hemorrhage while maintaining blood flow to the heart and brain.

“With a lot of innovation, it’s about fast forwarding to the past,” said Ward.

Physicians have been using the REBOA technique intermittently since the 1950s, but it wasn’t popularized until recently when Dr. Jon Eliason, a U-M vascular surgeon, worked with colleagues from the DoD. Together they to developed new, innovative designs in the REBOA catheter making it easier to use in trauma centers.

Now, Ward wants to do the same for GROA. Ward and his team just received $3M in funding from the DoD’s Prolonged Field Care Research award to develop GROA further. In total, four MCIRCC projects were selected by the DoD receiving $10.5M in funding.

An illustration of how the GROA device might look.

An illustration of how the GROA device might look.

Dr. Ward and his team are working with the University of Michigan Morphomics Analysis Group led by Dr. Stewart Wang, a U-M trauma surgeon, to analyze hundreds of cross-sectional abdominal CAT scans. They are collecting data, such as the average stomach size and aorta placement, which will help them improve the design.

The team also consist of collaborators in the Departments of Mechanical Engineering, Biomedical Engineering, and Surgery to help design and develop the device. As iterations of the device are finished, he’ll be working with MCIRCC’s Large Animal Operative and Intensive Care Unit led by Hakam Tiba, MD, to test the design and the effectiveness of the treatment.

Dr. Ward envisions that GROA will also be used in civilian settings, such as a car accident, allowing first-responder paramedics to stop hemorrhaging at the site of the injury.

“This isn’t designed to replace REBOA, but to serve as a bridge until REBOA or surgery is made possible,” said Ward.

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Using the Eye as a Window to the Brain

When first responders are faced with the challenge of caring for a patient with a traumatic brain injury (TBI), whether that be in the Emergency Room, out in the field, or on the front lines, two dilemmas usually come to mind: what is the extent of their initial injury, and are there any secondary injuries underway?

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Valproic Acid for Prolonged Field Care

Most Americans are privileged in that if we suffer a serious injury, we’re able to call an ambulance and be rushed to the necessary level of care. Unfortunately, our troops abroad do not have that luxury. As wars become more dangerous, battlefields become more isolated.