In this episode, we explore how REBOA can become an integrated tool for deliberate physiologic support in profound shock. REBOA is a word that immediately commands attention in pre-hospital care. For many teams, it represents the edge of capability, a high-stakes intervention reserved for catastrophic haemorrhage and profound shock.  Many clinicians still think of it primarily as a haemorrhage-control device: inflate fully, plug the leak, and hope for the best. But in profound shock, bleeding is only part of the problem. Coronary perfusion hinges on proximal aortic diastolic pressure, and if the heart isn’t being perfused, everything else we do is on borrowed time.

Today’s guests, Dr Jon Barratt and Dr Halden Hutchinson-Bazely, sit at the cutting edge of this shift in thinking. Jon is a Consultant in Emergency Medicine and Pre-Hospital Emergency Medicine with the British Army and the NHS, serving as Clinical Lead for Research and Clinical Innovation at Yorkshire Air Ambulance and as a MERIT Consultant with West Midlands Ambulance Service. He is a Senior Lecturer with the Academic Department of Military Emergency Medicine and a founding force behind the SPEAR programme, a resuscitation training initiative that leverages ultrasound-guided arterial access and physiologic targets to support patients in deep shock. Jon was also principal investigator for the ERICA-ARREST trial, investigating the use of REBOA to augment coronary perfusion in out-of-hospital cardiac arrest. 

Hutch is a pre-hospital care doctor at London's Air Ambulance (LAA), specialising in exsanguination, and an intensive care doctor at St Bartholomew’s Hospital, specialising in ECMO. He is practising in endovascular resuscitation across the spectrum of the medical and trauma fields. Together with Jon, he is a SPEAR and EVTM faculty member and was an investigator for ERICA-ARREST. He brings a thoughtful and clinically grounded perspective to trauma management, with a focus on practical decision-making in high-pressure environments. His work reflects a commitment to evidence-informed practice and continual learning within acute care systems.

You can find more on SPEAR here: https://journals.sagepub.com/doi/10.1177/11297298241242157

And here: https://www.eaaa.org.uk/what-we-do/research-and-education/clinical-education/spear