Ultrasound assessment is useful for evaluating balloon volume of resuscitative endovascular balloon occlusion of the aorta.
Balloon volume
Degree of occlusion
Partial REBOA
REBOA
Ultrasound
Journal
European journal of trauma and emergency surgery : official publication of the European Trauma Society
ISSN: 1863-9941
Titre abrégé: Eur J Trauma Emerg Surg
Pays: Germany
ID NLM: 101313350
Informations de publication
Date de publication:
10 Jul 2023
10 Jul 2023
Historique:
received:
07
02
2023
accepted:
20
06
2023
medline:
11
7
2023
pubmed:
11
7
2023
entrez:
10
7
2023
Statut:
aheadofprint
Résumé
Endovascular balloon occlusion of the aorta (EBOA) increases proximal arterial pressure but may also induce life-threatening ischemic complications. Although partial REBOA (P-REBOA) mitigates distal ischemia, it requires invasive monitoring of femoral artery pressure for titration. In this study, we aimed to titrate P-REBOA to prevent high-degree P-REBOA using ultrasound assessment of femoral arterial flow. Proximal (carotid) and distal (femoral) arterial pressures were recorded, and perfusion velocity of distal arterial pressures was measured by pulse wave Doppler. Systolic and diastolic peak velocities were measured among all ten pigs. Total REBOA was defined as a cessation of distal pulse pressure, and maximum balloon volume was documented. The balloon volume (BV) was titrated at 20% increments of maximum capacity to adjust the degree of P-REBOA. The distal/proximal arterial pressure gradient and the perfusion velocity of distal arterial pressures were recorded. Proximal blood pressure increased with increasing BV. Distal pressure decreased with increasing BV, and distal pressure sharply decreased by > 80% of BV. Both systolic and diastolic velocities of the distal arterial pressure decreased with increasing BV. Diastolic velocity could not be recorded when the BV of REBOA was > 80%. The diastolic peak velocity in the femoral artery disappeared when %BV was > 80%. Evaluation of the femoral artery pressure by pulse wave Doppler may predict the degree of P-REBOA without invasive arterial monitoring.
Sections du résumé
BACKGROUND
BACKGROUND
Endovascular balloon occlusion of the aorta (EBOA) increases proximal arterial pressure but may also induce life-threatening ischemic complications. Although partial REBOA (P-REBOA) mitigates distal ischemia, it requires invasive monitoring of femoral artery pressure for titration. In this study, we aimed to titrate P-REBOA to prevent high-degree P-REBOA using ultrasound assessment of femoral arterial flow.
METHODS
METHODS
Proximal (carotid) and distal (femoral) arterial pressures were recorded, and perfusion velocity of distal arterial pressures was measured by pulse wave Doppler. Systolic and diastolic peak velocities were measured among all ten pigs. Total REBOA was defined as a cessation of distal pulse pressure, and maximum balloon volume was documented. The balloon volume (BV) was titrated at 20% increments of maximum capacity to adjust the degree of P-REBOA. The distal/proximal arterial pressure gradient and the perfusion velocity of distal arterial pressures were recorded.
RESULTS
RESULTS
Proximal blood pressure increased with increasing BV. Distal pressure decreased with increasing BV, and distal pressure sharply decreased by > 80% of BV. Both systolic and diastolic velocities of the distal arterial pressure decreased with increasing BV. Diastolic velocity could not be recorded when the BV of REBOA was > 80%.
CONCLUSION
CONCLUSIONS
The diastolic peak velocity in the femoral artery disappeared when %BV was > 80%. Evaluation of the femoral artery pressure by pulse wave Doppler may predict the degree of P-REBOA without invasive arterial monitoring.
Identifiants
pubmed: 37430175
doi: 10.1007/s00068-023-02309-6
pii: 10.1007/s00068-023-02309-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
Références
Brenner M, Inaba K, Aiolfi A, AAST AORTA Study Group, 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.
doi: 10.1016/j.jamcollsurg.2018.01.044
pubmed: 29421694
Johnson NL, Wade CE, Fox EE, Emergent Truncal Hemorrhage Control Study Group, et al. Determination of optimal deployment strategy for REBOA in patients with non-compressible hemorrhage below the diaphragm. Trauma Surg Acute Care Open. 2021;6(1):e000660.
doi: 10.1136/tsaco-2020-000660
pubmed: 33693060
pmcid: 7907878
Laverty RB, Treffalls RN, McEntire SE, Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Investigators, et al. Life over limb: arterial access-related limb ischemic complications in 48-hour REBOA survivors. J Trauma Acute Care Surg. 2022;92(4):723–8.
doi: 10.1097/TA.0000000000003440
pubmed: 34789696
Joseph B, Zeeshan M, Sakran JV, et al. Nationwide analysis of resuscitative endovascular balloon occlusion of the aorta in civilian trauma. JAMA Surg. 2019;154(6):500–8.
doi: 10.1001/jamasurg.2019.0096
pubmed: 30892574
pmcid: 6584250
Manzano-Nunez R, Orlas CP, Herrera-Escobar JP, 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.
doi: 10.1097/TA.0000000000001978
pubmed: 29787536
Russo RM, White JM, Baer DG. Partial resuscitative endovascular balloon occlusion of the aorta: a systematic review of the preclinical and clinical literature. J Surg Res. 2021;262:101–14.
doi: 10.1016/j.jss.2020.12.054
pubmed: 33561721
Kemp MT, Wakam GK, Williams AM, et al. A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration. J Trauma Acute Care Surg. 2021;90(3):426–33.
doi: 10.1097/TA.0000000000003042
pubmed: 33492106
Forte DM, Do WS, Weiss JB, et al. Validation of a novel partial resuscitative endovascular balloon occlusion of the aorta device in a swine hemorrhagic shock model: fine tuning flow to optimize bleeding control and reperfusion injury. J Trauma Acute Care Surg. 2020;89(1):58–67.
doi: 10.1097/TA.0000000000002718
pubmed: 32569103
Russo RM, Neff LP, Lamb CM, 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.
doi: 10.1016/j.jamcollsurg.2016.04.037
pubmed: 27138649
Matsumura Y, Higashi A, Izawa Y, et al. Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA). Eur J Trauma Emerg Surg. 2021;47(4):1023–9.
doi: 10.1007/s00068-019-01257-4
pubmed: 31696263
Matsumura Y, Higashi A, Izawa Y, et al. Organ ischemia during partial resuscitative endovascular balloon occlusion of the aorta: dynamic 4D computed tomography in swine. Sci Rep. 2020;10(1):5680.
doi: 10.1038/s41598-020-62582-y
pubmed: 32231232
pmcid: 7105501
Teeter WA, Matsumoto J, Idoguchi K, et al. Smaller introducer sheaths for REBOA may be associated with fewer complications. J Trauma Acute Care Surg. 2016;81(6):1039–45.
doi: 10.1097/TA.0000000000001143
pubmed: 27244576
Inoue J, Shiraishi A, Yoshiyuki A, et al. Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: a propensity score analysis. J Trauma Acute Care Surg. 2016;80(4):559–66 (discussion 566–7).
doi: 10.1097/TA.0000000000000968
pubmed: 26808039
Plurad DS, Chiu W, Raja AS, et al. Monitoring modalities and assessment of fluid status: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2018;84(1):37–49.
doi: 10.1097/TA.0000000000001719
pubmed: 29019796
Dinsmore M, Venkatraghavan L. Clinical applications of point-of-care ultrasound in brain injury: a narrative review. Anaesthesia. 2022;77(Suppl 1):69–77.
doi: 10.1111/anae.15604
pubmed: 35001377
Reva VA, Perevedentcev AV, Pochtarnik AA, et al. Ultrasound-guided versus blind vascular access followed by REBOA on board of a medical helicopter in a hemorrhagic ovine model. Injury. 2021;52(2):175–81.
doi: 10.1016/j.injury.2020.09.053
pubmed: 33004204
Qadri HI, Patel NT, Ganapathy AS, et al. Maintaining zone 1 occlusion is a dynamic process: the effects of proximal pressure and blood transfusion during REBOA. Am Surg. 2022;88(7):1496–503.
doi: 10.1177/00031348221082284
pubmed: 35443811