Top

European Journal of Trauma and Emergency Surgery

Published in:

01-08-2021 | Computed Tomography | Original Article

Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA)

Authors: Yosuke Matsumura, Akiko Higashi, Yoshimitsu Izawa, Shuji Hishikawa, Hiroshi Kondo, Viktor Reva, Shigeto Oda, Junichi Matsumoto

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2021

Abstract

Introduction

Resuscitative endovascular balloon occlusion of the aorta (REBOA) increases proximal arterial pressure, but may also induce life-threatening distal ischemia. Partial REBOA (P-REBOA) is thought to mitigate distal ischemia during aortic occlusion. However, feasible indicators of the degree of P-REBOA remain inconsistent. We hypothesised percent balloon volume could be a substitute for pressure measurements of gradients during P- REBOA. This study aimed to compare balloon volume and arterial pressure gradient, and analysed with intra-balloon pressure and balloon shape.

Methods

Proximal (carotid) and distal (femoral) arterial pressures were recorded and a 7-Fr REBOA catheter was placed in four swine. Total REBOA was defined as a cessation of distal pulse pressure and maximum balloon volume was documented. The balloon volume was titrated by 20% increments of maximum capacity to adjust the degree of P-REBOA. The distal/proximal arterial pressure gradient and the intra-balloon pressures were also recorded. The changes in shape and the cross-sectional area of the balloon were evaluated with computed tomography (CT) images.

Results

The proximal mean arterial pressure (MAP) plateaued after 60% balloon volume; meanwhile, distal pulse pressure was still left. The balloon pressure was traced with proximal MAP before contact with aortic wall. The balloon shape changed unevenly from “cone” to “spindle” shape, although the balloon cross-sectional area of the mid-segment linearly increased.

Conclusion

Monitoring distal pressure and titrating percent balloon volume is feasible to manage P-REBOA. In this experiment, 60% balloon volume was enough inflation to elevate central pressure allowing distal perfusion. The intra-balloon pressure was not reliable due to the strong influence of proximal MAP and uneven change of the balloon shape.

Available only for authorised users

Sadeghi M, Nilsson KF, Larzon T, Pirouzram A, Toivola A, Skoog P, et al. The use of aortic balloon occlusion in traumatic shock: first report from the ABO trauma registry. Eur J Trauma Emerg Surg. 2018;44(4):491–501. https://doi.org/10.1007/s00068-017-0813-7.CrossRefPubMed

Matsumura Y, Matsumoto J, Kondo H, Idoguchi K, Funabiki T, investigators D-I. Partial occlusion, conversion from thoracotomy, undelayed but shorter occlusion: resuscitative endovascular balloon occlusion of the aorta strategy in Japan. Eur J Emerg Med. 2018;25(5):348–54. https://doi.org/10.1097/MEJ.0000000000000466.CrossRefPubMed

Brenner M, Inaba K, Aiolfi A, DuBose J, Fabian T, Bee T, et al. Resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy in select patients with hemorrhagic shock: early results from the american association for the surgery of Trauma's aortic occlusion in resuscitation for trauma and acute care surgery registry. J Am Coll Surg. 2018;226(5):730–40. https://doi.org/10.1016/j.jamcollsurg.2018.01.044.CrossRefPubMed

Lendrum R, Perkins Z, Chana M, Marsden M, Davenport R, Grier G, et al. Pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) for exsanguinating pelvic haemorrhage. Resuscitation. 2019;135:6–13. https://doi.org/10.1016/j.resuscitation.2018.12.018.CrossRefPubMed

Manzano-Nunez R, Orlas CP, Herrera-Escobar JP, Galvagno S, DuBose J, Melendez JJ, et al. A meta-analysis of the incidence of complications associated with groin access after the use of resuscitative endovascular balloon occlusion of the aorta in trauma patients. J Trauma Acute Care Surg. 2018;85(3):626–34. https://doi.org/10.1097/TA.0000000000001978.CrossRefPubMed

Davidson AJ, Russo RM, Reva VA, Brenner ML, Moore LJ, Ball C, et al. The pitfalls of resuscitative endovascular balloon occlusion of the aorta: risk factors and mitigation strategies. J Trauma Acute Care Surg. 2018;84(1):192–202. https://doi.org/10.1097/TA.0000000000001711.CrossRefPubMed

Taylor JR 3rd, Harvin JA, Martin C, Holcomb JB, Moore LJ. Vascular complications from resuscitative endovascular balloon occlusion of the aorta: life over limb? J Trauma Acute Care Surg. 2017;83(1 Suppl 1):S120–S123123. https://doi.org/10.1097/TA.0000000000001514.CrossRefPubMed

Joseph B, Zeeshan M, Sakran JV, Hamidi M, Kulvatunyou N, Khan M, et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in Civilian Trauma. JAMA Surg. 2019. https://doi.org/10.1001/jamasurg.2019.0096.CrossRefPubMedPubMedCentral

Matsumura Y, Matsumoto J, Kondo H, Idoguchi K, Ishida T, Kon Y, et al. Fewer REBOA complications with smaller devices and partial occlusion: evidence from a multicentre registry in Japan. Emerg Med J. 2017;34(12):793–9. https://doi.org/10.1136/emermed-2016-206383.CrossRefPubMed

10.

Reva VA, Matsumura Y, Horer T, Sveklov DA, Denisov AV, Telickiy SY, et al. Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock? Eur J Trauma Emerg Surg. 2018;44(4):511–8. https://doi.org/10.1007/s00068-016-0732-z.CrossRefPubMed

11.

Russo RM, Williams TK, Grayson JK, Lamb CM, Cannon JW, Clement NF, et al. Extending the golden hour: Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. J Trauma Acute Care Surg. 2016;80(3):372–8. https://doi.org/10.1097/TA.0000000000000940(discussion 8–80).CrossRefPubMed

12.

Kuckelman J, Barron M, Moe D, Derickson M, Phillips C, Kononchik J, et al. Extending the golden hour for zone 1 reboa: improved survival and reperfusion injury with intermittent versus continuous reboa in a porcine severe truncal hemorrhage model. J Trauma Acute Care Surg. 2018. https://doi.org/10.1097/TA.0000000000001964.CrossRefPubMed

13.

Sadeghi M, Horer TM, Forsman D, Dogan EM, Jansson K, Kindler C, et al. Blood pressure targeting by partial REBOA is possible in severe hemorrhagic shock in pigs and produces less circulatory, metabolic and inflammatory sequelae than total REBOA. Injury. 2018;49(12):2132–41. https://doi.org/10.1016/j.injury.2018.09.052.CrossRefPubMed

14.

Madurska MJ, Jansen JO, Reva VA, Mirghani M, Morrison JJ. The compatibility of computed tomography scanning and partial REBOA: a large animal pilot study. J Trauma Acute Care Surg. 2017;83(3):557–61. https://doi.org/10.1097/TA.0000000000001574.CrossRefPubMed

15.

Reva VA, Matsumura Y, Samokhvalov IM, Pochtarnik AA, Zheleznyak IS, Mikhailovskaya EM, et al. Defining degree of aortic occlusion for partial-REBOA: a computed tomography study on large animals. Injury. 2018;49(6):1058–63. https://doi.org/10.1016/j.injury.2018.04.021.CrossRefPubMed

16.

Russo RM, Neff LP, Lamb CM, Cannon JW, Galante JM, Clement NF, et al. Partial resuscitative endovascular balloon occlusion of the aorta in swine model of hemorrhagic shock. J Am Coll Surg. 2016;223(2):359–68. https://doi.org/10.1016/j.jamcollsurg.2016.04.037.CrossRefPubMed

17.

Johnson MA, Neff LP, Williams TK, DuBose JJ, Group ES. Partial resuscitative balloon occlusion of the aorta (P-REBOA): Clinical technique and rationale. J Trauma Acute Care Surg. 2016;81(5 Suppl 2):S133–S137137. https://doi.org/10.1097/TA.0000000000001146.CrossRefPubMed

18.

Williams TK, Neff LP, Johnson MA, Ferencz SA, Davidson AJ, Russo RM, et al. Extending resuscitative endovascular balloon occlusion of the aorta: endovascular variable aortic control in a lethal model of hemorrhagic shock. J Trauma Acute Care Surg. 2016;81(2):294–301. https://doi.org/10.1097/TA.0000000000001075.CrossRefPubMedPubMedCentral

19.

Brenner M, Hoehn M, Pasley J, Dubose J, Stein D, Scalea T. Basic endovascular skills for trauma course: bridging the gap between endovascular techniques and the acute care surgeon. J Trauma Acute Care Surg. 2014;77(2):286–91. https://doi.org/10.1097/TA.0000000000000310.CrossRefPubMed

20.

Biffl WL, Fox CJ, Moore EE. The role of REBOA in the control of exsanguinating torso hemorrhage. J Trauma Acute Care Surg. 2015;78(5):1054–8. https://doi.org/10.1097/TA.0000000000000609.CrossRefPubMed

21.

Rasmussen TE. Update on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Remote Damage Control Resuscitation Symposium. 2016. https://rdcr.org/wp-content/uploads/2016/07/13-Rasmussen-20116-RDCR-Symposium-V2.pdf. Accessed 15 Nov 2019

Title: Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA)
Authors: Yosuke Matsumura
Akiko Higashi
Yoshimitsu Izawa
Shuji Hishikawa
Hiroshi Kondo
Viktor Reva
Shigeto Oda
Junichi Matsumoto
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01257-4

ACC 2024 Congress

Springer Medicine

Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA)

Abstract

Introduction

Methods

Results

Conclusion

ACC 2024 Congress

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2021

Ligamentous Lisfranc injuries: analysis of CT findings under weightbearing

The effect of postoperative respiratory and mobilization interventions on postoperative complications following abdominal surgery: a systematic review and meta-analysis

Intermediate-term evaluation of interval appendectomy in the pediatric population

The evaluation of pulmonary function after rib fixation for multiple rib fractures and flail chest: a retrospective study and systematic review of the current evidence

Correlation of procalcitonin to positive blood culture results in a sample of South African trauma ICU patients between 2016 and 2017

Injury patterns and outcomes associated with fractures of the native distal femur in adults