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SCOTTISH HOSPITAL NEWS


LIFE-SAVING TECHNIQUE TRIALLED AS PART OF UNIVERSITY STUDY


An emergency treatment that could save the lives of car crash victims and others with life-threatening bleeding injuries is to be trialled as part of a new £1.1m study by the University of Aberdeen.


The technique which involves temporarily stopping the blood flow to the lower part of the body until patients can be taken to an operating theatre is to be used at a number of major trauma centres during the trial.


The REBOA technique will be used only on patients with uncontrolled, life-threatening bleeding from injuries to the torso.


This type of injury, often seen in car crash victims or people who have fallen from height, is the most common cause of preventable death in trauma patients.


Whilst a limb can be compressed to reduce blood loss, severe bleeding in the abdomen or chest usually requires an operation to stop it. As a result people with such injuries can bleed to death before they reach an operating theatre.


REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) works by inserting a balloon device, through the femoral artery in the groin, into the body’s main artery.


Once above the location of the injury, the balloon is inflated, blocking the artery and stopping the blood flow to the injured parts of the body but, crucially, maintaining it around vital organs – the heart and the brain.


The procedure allows an Emergency department’s Trauma Team more time to prepare the patient for


surgery.


The trial will compare the survival of those who receive REBOA and those who do not in order to establish whether it is an effective intervention.


REBOA is already used in trauma centres in the USA, Japan and parts of Europe but so far in the UK only the Royal London Hospital and the London Air Ambulance have used the technology.


‘REBOA is quite a simple concept which many in the medical profession believe will be a tool that helps save more lives,’ explains Jan Jansen, a consultant in general surgery and intensive care medicine and honorary senior clinical lecturer at the University of Aberdeen, and the chief investigator of the study. ‘This trial will provide evidence that either supports or refutes that conception. The technology is not without its complications. Cutting off blood from half the body can only be done for so long and you have to deal with the consequences of that but with injuries this severe it can be a trade-off worth making. We want to find out if it is worth taking an extra few minutes to do this procedure and arrive in the theatre in a more controlled state.


‘It’s important to stress that this procedure is only used in extreme cases where there is a real chance of the patient dying in the emergency department.


‘All teams involved will be given bespoke training and as well as assessing the success of REBOA we will be evaluating how practical it is to incorporate into the procedures of each individual trauma team. Some early adopter teams have already started using this but this trial will provide some thorough research that shows just how effective it is at saving lives.’


SCIENTISTS PINPOINT KEY BOWEL DISEASE GENE


A key gene that helps to explain an underlying cause of incurable bowel disorders such as Crohn’s disease has been identified by scientists.


Blocking the gene harms vital parts of the cell and leads to bowel disease, while targeting these vital cell parts with drugs can reverse damage, the study shows.


The findings aid understanding of the cause of these lifelong conditions and could lead to new


treatments, the scientists say.


Inflammatory bowel disease (IBD) includes Crohn’s disease and ulcerative colitis and currently affects around 300,000 people in the UK. The causes of these disorders are unknown and there is currently no cure.


The gene – known as MDR1 – governs an important extractor system for toxins in the gut, removing damaging substances from intestinal cells.


SMC REVERSES PREVIOUS DECISION ON KADCYLA


The Scottish Medicines Consortium (SMC) has reversed a decision from October 2014 and has now recommended Kadcyla to be routinely available across Scotland for women with advanced HER2- positive breast cancer for the first time. This news will be welcomed by the many women in Scotland living with one of the most aggressive forms of breast cancer who have never had access to Kadcyla before.


The news has also been welcomed by Roche UK, the manufacturer of the drug.


‘For more than two years,’ said Richard Erwin, General Manager, Roche UK women in Scotland with this aggressive disease have been denied access to this life extending medication through the NHS.


Meanwhile, women in England have been able to freely access it via the English Cancer Drugs Fund (CDF).


‘Women with advanced HER2- positive breast cancer in Scotland will now be able to access Kadcyla, which is clinically proven to extend their lives by an average of 5.8 months compared to the previous standard of care.


‘Throughout the reassessment of Kadcyla, Roche has worked collaboratively with patient groups and groups within NHS Scotland to find a solution that makes this important life-extending medicine available for women in Scotland. Roche has offered an improved patient access scheme, which has been accepted by the SMC. This demonstrates that, when we all work together, we can find successful solutions that work for patients and the health system alike.’


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