Table 1 Characteristics of civilian prehospital teams with experience in the use of REBOA

Sadek 2016 [11] (London—United Kingdom)

London’s Air Ambulance (LAA) based at the Royal London Hospital:

The experienced physician–paramedic team provides a 24-h dedicated trauma service to the 10 million inhabitants of London, attending approximately 1800 patients per year. The hospital is a Major Trauma Center and has approximately 3500 full trauma team activations per year

All REBOA procedures were performed by physicians with multi-specialty backgrounds including Emergency Medicine, Anesthesia, and Intensive Care Medicine

The pre-hospital team is trained in advanced prehospital interventions such as rapid sequence of anesthesia, blood transfusion and resuscitative thoracotomy. The team is able to activate in-hospital major hemorrhage protocols

A multidisciplinary working group to investigate the pre-hospital REBOA potential role was created. The group consisted of clinicians from pre-hospital care, emergency medicine, trauma surgery, interventional radiology, anesthesia, and intensive care medicine

A protocol for pre-hospital REBOA was produced along with a structured training, education, and governance program. In addition, the Pre-hospital, and Emergency Department Endovascular Resuscitation (PEER) Course was created to disseminate knowledge within the wider pre-hospital and in-hospital team

Training included scripted scenarios used in high-fidelity, training “moulages” to test the trainees’ leadership, decision-making, teamwork, and procedural competence [19]

Injury to arrival on scene: 34 min

Dispatch to procedure start: NR

Dispatch to occlusion, min: NR

Procedure time, min: NR

Occlusion time, min: NR

Dispatch to ROSC, min: NR

Lendrum 2019 [12] (London—United Kingdom)

Injury to arrival on scene, median (IQR): 21 (18–26) min

Dispatch to procedure start, min: NR

Dispatch to occlusion, min: NR

Procedure time, min: NR

Occlusion time, median (IQR): 80 min (75–115) min

Dispatch to ROSC, min: NR

Brede 2019 [15] (Trondheim—Norway)

Trondheim´s Helicopter Emergency Medical Service (HEMS) based at St. Olavs Hospital:

The physician-leaded HEMS has a catchment population of about 700.000 and usually transfer patients with OHCA to this tertiary university hospital. The service dispose both a helicopter and a rapid response car

All physicians are board certified qualified anesthesiologist with prehospital work experience from 4 to 18 years. The paramedics have from 11 to 34 years work experience in the service. Eight physicians and 5 paramedics participated, and all completed a structured training program before entering the study

All anesthesiologists are skilled in establishing central vascular lines using the Seldinger technique and ultrasound. The team was capable of assuring an optimal advanced cardiac life support (ACLS) resuscitation, using a chest compression machine and performing endotracheal intubation. They also measured invasive arterial BP via the left radial or brachial artery at 1-min intervals in the 2021 cohort

They created a safety monitoring group specifically focused on correct catheter placement and the quality of advanced resuscitation, following a 3-step safety assurance system

The training program included theoretical education, training on a special designed simulation mannequin, training during elective angiography procedures, and high-fidelity simulation

Performance was evaluated with a global rating scale and all participants had to perform above a predefined score to complete the training program. Details of the training program have been reported [18]

Dispatch to arrival on scene, min: NR

Dispatch to procedure start: NR

Dispatch to occlusion, mean (range) 45.6 (34–57) min

Procedure time, mean (range) 11.7 (8–16) min

Occlusion time, mean 9.5 (3–19) min*

Dispatch to ROSC, mean: 53.3 (37–58) min

*Occlusion times are only indicated for patients with ROSC

Brede 2021 [17] (Trondheim—Norway)

Dispatch to arrival on scene, median (IQR):29 (10–38) min

Dispatch to procedure start: NR

Dispatch to occlusion, median (IQR): 50 (39–72) min

Procedure time, min: NR

Occlusion time, min: NR

Dispatch to ROSC, mean (range): 53.5 (50–57) min

Gamberini 2021 [16] (Bologna—Italy)

Bologna´s Helicopter Emergency Medical Service (HEMS) based at Maggiore Carlo Alberto Pizzardi Hospital:

This hospital is a level 1 Trauma and stroke center with 927 beds. It also includes the Emergency Medical Services Dispatch center and the local HEMS base covering a 2.5 million inhabitants’ area. They receive an average of 180 OHCA patients per year from both EMS and HEMS

For procedures managed by the HEMS crews, a UCI Intensivist performs REBOA assisted by one of the two HEMS nurses while the second nurse ensures that quality CPR is delivered by the crews of the ground vehicles dispatched together with HEMS

The prehospital team is capable of assuring ACLS and performing maneuvers such as finger thoracostomy, pericardiocentesis and eFAST. If necessary, chest compression device and portable ventilators are available

All the attending intensivists have a significant experience in ultrasound-guided arterial cannulation because of the trauma management background

The REBOA technique was acquired by the trauma ICU intensivists in 2015 and the same group of 17 physicians covers a 24 h/7d shift in the local HEMS

Each member of the team directly performed or collaborated to at least two REBOA procedures before conducting the technique independently. Mandatory simulation-based retraining is performed every 6 months

Dispatch to arrival on scene, median (IQR): 12.5 (6–16.5) min

Dispatch to procedure start, median (IQR): 26.5 (24.5–46.5) min

Dispatch to occlusion, median (IQR): 38 (34.5–48.5) min

Procedure time, median (IQR): 9 (9–10.75) min

Occlusion time, min: NR *

Dispatch to ROSC, min: NR*

*No available data due to not achieved sustained ROSC in the Prehospital group. Median time of occlusion was 32 min for all the patients (ED and HEMS)