A tiny device has a huge impact for severely injured patients
The region’s most gravely injured patients have a better chance of survival thanks to a tiny device that’s now part of Hamilton Health Sciences (HHS)’ Hamilton General Hospital’s standard lifesaving equipment.
HHS Hamilton General Hospital (HGH) is the regional trauma centre for south-central Ontario, where the area’s most seriously injured and sick patients receive care. For the past year-and-a-half, the HGH trauma team has been trialing a small, innovative medical device called the COBRA-OS to slow down excessive internal bleeding so severely-injured patients can be stabilized long enough for potentially lifesaving surgery. COBRA-OS stands for Control of Bleeding, Resuscitation, Arterial Occlusion System. Results of the trial were so promising, HGH now stocks this device as a standard tool in its trauma bay.
“At Hamilton Health Sciences, we’re committed to finding innovative solutions to help our patients and the community.” — Dr. Ted Scott, HHS vice president of innovation and partnerships
By feeding a tiny tube up a patient’s arteries from their thigh to their heart, and then expanding a small blocker balloon inside the biggest artery in the body, emergency department teams can now slow down bleeding enough for surgeons to attempt to repair the major injuries.
Reserved for the most serious cases
The COBRA-OS is used only for the most severe trauma cases, says Dr. Paul Engels, HHS trauma surgeon and trauma medical director. For example, during the trial, which lasted over a year, it was used just six times, with four of the patients surviving. The COBRA-OS is credited with playing a key role in saving those lives.
The COBRA-OS is a small device, so there’s less risk of complications in accessing a patient’s vessels.
“This device is used to stabilize bleeding that can’t otherwise be controlled,” says Engels. “These are patients who are at serious risk of dying before we can get them into the operating theatre.” As well as being potentially lifesaving for trauma patients, this device can also be used for surgical and critical care patients experiencing severe internal bleeding.
Engels was the first member of the HGH team to use the COBRA-OS on a patient who arrived in the trauma bay with multiple gunshot wounds to the chest and abdomen.
“It worked very well, and was as easy to insert in this emergency situation as it was during our training,” says Engels, who credits this device with saving the patient’s life. “The clinical team reviewing this case was of opinion that without the use of the COBRA-OS, this patient would not have survived.”
“Its small size makes it an excellent tool, and we’re thrilled to now have it, permanently, in our trauma bay.” — Dr. Paul Engels, HHS trauma surgeon and trauma medical director.
The COBRA-OS was developed by Front Line Medical Technologies, a medical device company in London, Ontario that specializes in bleeding control and resuscitation. The company’s co-founder and chief medical officer Dr. Adam Power is a graduate of McMaster University’s general surgery program.
“As an alumnus of the McMaster University general surgery program, I was so proud to come back to Hamilton to help introduce this life-saving device to my colleagues for their trauma patients,” says Power, who’s also a vascular surgeon in London.
How it works
The tool is used to stop internal bleeding by temporarily halting blood flow in the aorta, the largest artery in the body, from inside the vessel. The goal is for this controlled, temporary stoppage of blood flow to stabilize the patient long enough for the trauma team and surgeons to intervene and start repairing the bleeding injuries. This method is minimally invasive, only requiring a tiny opening.
A very thin catheter is inserted into the patient’s groin through the femoral artery and then snaked up to the aorta where a tiny balloon is expanded to temporarily block the blood flow. This can buy enough time for the trauma team to get the patient to a surgical suite for emergency surgery. Depending on placement, the balloon temporarily stems blood flow to the pelvis or abdominal area.
Before trialing the COBRA-OS, the process for clamping the aorta to slow down bleeding in trauma cases was far more aggressive, consisting of opening the left side of the chest and compressing the aorta externally. “This method is very invasive with less chance of survival,” says Engels.
Bringing innovative new treatments to HHS
Dr. Ted Scott, HHS vice president of innovation and partnerships
The hospital’s innovation team, led by Dr. Ted Scott, HHS vice president of innovation and partnerships, brought the opportunity to trial the COBRA-OS to the HGH trauma team, with support from OBIO’s Early Adopter Health Network (EAHN) program. OBIO, a not-for-profit, membership-based organization dedicated to advancing health technology innovation and commercialization, is prioritizing the evaluation and adoption of new technologies through EAHN.
“This evaluation highlights HHS’ intention to adopt world-class innovations and their propensity to collaborate with pioneering local companies like Front Line Medical Technologies.” — Dr. Maura Campbell, OBIO president and CEO.
“At Hamilton Health Sciences, we’re committed to finding innovative solutions to help our patients and the community,” says Scott. “Collaborating with organizations like OBIO is an essential part of developing partnerships with the right companies to make impactful change. When it comes to trauma patients, every second counts. So, as the Regional Trauma Centre for Central-South Ontario, it’s our responsibility to explore all ways to use the limited time we have to save a patient’s life.”
OBIO is engaged in strategy, programming, policy development and advocacy to address the needs of the next generation of companies developing innovative human health products. Dr. Maura Campbell is OBIO’s president and CEO.
“Through the EAHN program, OBIO is pleased to support the adoption of a made-in-Ontario solution that has the potential to save lives,” says Campbell. “HHS has been an important partner for EAHN since its inception in 2019. This evaluation highlights HHS’ intention to adopt world-class innovations and their propensity to collaborate with pioneering local companies like Front Line Medical Technologies.”
While the COBRA-OS was developed by a Canadian company and is approved by Health Canada, it’s currently far more common in American trauma centres. Hamilton General Hospital was one of a handful of Ontario hospitals to trial the device through OBIO’s Early Adopter Health Network.
Another similar device, produced by a different company, is used by some Canadian trauma centres but this tool is larger in size. “The smaller profile of the COBRA-OS means less risk of complications in accessing the patient’s vessels,” says Engels, adding, “Its small size makes it an excellent tool, and we’re thrilled to now have it, permanently, in our trauma bay.”
Now that the HGH trauma team is fully trained in its use, Engels estimates that up to 10 patients per year would be in critical enough condition to need the COBRA-OS.
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