Approximation of Pediatric Morphometry for Resuscitative Endovascular Balloon Occlusion of the Aorta

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Erik Scott DeSoucy ◽  
Alfred Francois Trappey ◽  
Andrew M Wishy ◽  
Meryl A Simon ◽  
Anders J Davidson ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Pediatric Patients ◽  
Balloon Catheter ◽  
Vessel Diameter ◽  
Balloon Occlusion ◽  
Solid Organ ◽  
Regression Equations ◽  
Access Site ◽  
Normal Ranges ◽  
Endovascular Balloon Occlusion

Background Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be beneficial in the management of traumatic and iatrogenic vascular and solid organ injuries in children, but requires an understanding of vessel diameter at the access site and landing zones. We sought to adapt the Broselow™ Tape method to estimation of aortic and femoral artery diameters for this purpose. Methods Computed tomography scans from trauma and non-trauma pediatric patients at a level 1 trauma center were reviewed for vascular dimensions at aorta Zone I, Zone III and the common femoral artery (CFA). Vessel size was measured by two providers using a vascular software suite with a 10% interobserver comparison. Height was used to create linear regression equations for each location and calculate ranges for each Broselow™ Tape category. Results We reviewed scans from 110 patients ages 2-14 years with less than 8% interobserver variability. 64% were male and 46% were trauma patients. Height based regression equations were closely correlated with vessel diameter:  Zone I(mm)=[0.093±0.006·height(cm)]+0.589±0.768; R2=0.714, p<0.001 Zone III(mm)=[0.083±0.005·height(cm)]–0.703±0.660; R2=0.728, p<0.001 CFA(mm)=[0.043±0.003·height(cm)]+0.644±0.419; R2=0.642, p<0.001 These equations, along with the minimum and maximum length for each Broselow™ Tape color, were used to define color coded normal ranges for each REBOA landing zone and access site. Conclusion Knowledge of the access vessel and occlusion zone diameters in pediatric patients is crucial for future research and application of REBOA in this population. Furthermore, an adapted Broselow™ Tape including these measurements would assist in appropriate sheath and balloon catheter selection in emergent settings.

A new, pressure-regulated balloon catheter for partial resuscitative endovascular balloon occlusion of the aorta (REBOA)

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Rachel M. Russo ◽  
Curtis J. Franklin ◽  
Anders J. Davidson ◽  
Patricia L. Carlisle ◽  
Ariella M. Iancu ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Endovascular Balloon Occlusion

scholarly journals Vascular Access Training for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Placement: A Feasibility Study in Emergency Physicians

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Suzanne Vrancken ◽  
Rayner Maayen ◽  
Boudewijn Borger van der Burg ◽  
Daniël Eefting ◽  
Thijs Van Dongen ◽  
...  
Keyword(s):  
Training Program ◽  
Vascular Access ◽  
Femoral Artery ◽  
Technical Skills ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Puncture Site ◽  
Anatomical Structures ◽  
And Training ◽  
Endovascular Balloon Occlusion

Background Vascular access is a prerequisite for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) placement. Training such skills to emergency physicians (EPs) could contribute to better outcomes in non-compressible truncal hemorrhage patients. This study aimed to determine whether a concise training program could train EPs to recognize anatomical structures and correctly visualize and identify the puncture site for percutaneous placement of a REBOA catheter. Methods Eleven EPs participated in our training program, including basic anatomy and training in access materials for REBOA. Participants underwent expert-guided practice on each other and were then tested on key skills to include: identification of anatomical structures, anatomical knowledge, technical skills for vascular access imaging with a handheld ultrasound, and time to identify adequate puncture site of the Common Femoral Artery (CFA) with ultrasound. Consultant vascular surgeons functioned as expert controls. Results EPs had a median overall technical skills score of 32.5 [27.0-35.0]. All EPs were able to identify the correct CFA puncture site with a median time of 52.9 seconds [35.6-63.7] at the first attempt and 34.0 seconds [21.2-44.7] at the post-test (Z=-2.756, p=0.006). Consultant vascular surgeons were significantly faster (p=0.000). Conclusions EPs are capable of visualizing the femoral artery and vein within one minute. The speed of correct visualisation improved rapidly after repetition. Our concise theoretical and practical training program proved useful regardless of prior endovascular experience and training. This program, as a component of an expanded Endovascular Resuscitation and Trauma Management curriculum, in combination with realistic task training models (simulator, perfused cadaver, or live tissue) has the potential to provide effective training of the skills required to competently perform REBOA.

New Techniques in Hemorrhage Control

2017 ◽  
Author(s):  
Megan Brenner ◽  
Joseph DuBose
Keyword(s):  
Treatment Algorithm ◽  
Balloon Occlusion ◽  
Published Data ◽  
Solid Organ ◽  
Stent Grafting ◽  
Pelvic Hemorrhage ◽  
Key Words Angiography ◽  
Vessel Injury ◽  
Definitive Therapy ◽  
Endovascular Balloon Occlusion

The use of interventional procedures in trauma has increased steadily over the past 10 years. With advancements in both imaging and device technology, endovascular techniques have become part of the treatment algorithm for both large and small vessel injury. Endovascular therapy in trauma involves a minimally invasive, catheter-based approach, which can be used as a temporizing measure in patients in extremis or as definitive therapy in a wide variety of diagnoses. Sheaths, catheters, and guide wires are universal instruments, regardless of procedure. Devices passed over guide wires form the basis of diagnosis and treatment. Using this technology provides many advantages to traditional open surgical therapy, namely the avoidance of large and potentially morbid incisions. Angioembolization, stent grafting, and resuscitative endovascular balloon occlusion of the aorta (REBOA) are being used with increasing frequency in trauma centers, with established algorithms, multiinstitutional trials, and more published data available, particularly for solid-organ and pelvic hemorrhage. Key words: angiography, embolization, hemorrhage, resuscitative endovascular balloon occlusion of the aorta, stent graft

scholarly journals Practical tips for performing resuscitative endovascular balloon occlusion of the aorta

2021 ◽  
pp. 102490792199442
Author(s):  
Sung Wook Chang ◽  
Dae Sung Ma ◽  
Ye Rim Chang ◽  
Dong Hun Kim
Keyword(s):  
Damage Control ◽  
Balloon Catheter ◽  
Common Femoral Artery ◽  
Balloon Occlusion ◽  
Trauma Patients ◽  
Arterial Access ◽  
Occlusion Time ◽  
Sheath Insertion ◽  
Multiple Trauma Patients ◽  
Endovascular Balloon Occlusion

Background: Hemorrhage is the leading cause of death in trauma settings. Non-compressible torso hemorrhage, which is caused by abdominopelvic and thoracic injuries, is an important cause of subsequent organ dysfunction and poor outcomes in multiple trauma patients. The management of hemodynamically unstable patients with non-compressible torso hemorrhage has changed, and the concept of damage control resuscitation has been developed in the last decades. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) as a method of temporary stabilization is the modern evolution of bleeding control, and it is in the middle of a paradigm shift as a treatment for non-compressible torso hemorrhage. Despite its effectiveness in patients with hemorrhagic shock, the application of REBOA remains limited because of lack of experience and troubleshooting guidelines. Objectives: The aim of study was to provide useful tips for the implementing a step-by-step procedure for REBOA in various hospital settings and capabilities. Methods: We introduced REBOA procedures using a REBOA-customized 7 Fr balloon catheter through the animation models or radiography from preparation to access, catheter management, and device removal after procedure completed. Results: We have described REBOA procedures as follows: identification of the common femoral artery, arterial access for placement of a guidewire, precautions during a sheath insertion, guidewire and balloon positioning in the aorta, occlusion zones and adjustment of balloon location, REBOA strategy for extending the occlusion time, balloon deflation and removal, sheath removal, and medical records. Conclusion: We believe that the practical tips mentioned in this article will help in performing the REBOA procedure systematically and developing an effective REBOA framework.

Improving the safety of resuscitative endovascular balloon occlusion of the aorta – Compliant versus semi-compliant balloon systems

Vascular ◽  
2020 ◽  
Vol 28 (5) ◽  
pp. 612-618
Author(s):  
Marta J Madurska ◽  
Curtis Franklin ◽  
Michael Richmond ◽  
Sakib M Adnan ◽  
Gerard P Stansby ◽  
...  
Keyword(s):  
Safety Valve ◽  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Quadratic Model ◽  
Second Phase ◽  
Relief Valve ◽  
Pressure Relief ◽  
Resuscitative Thoracotomy ◽  
Working Length ◽  
Endovascular Balloon Occlusion

Objectives Resuscitative endovascular balloon occlusion of the aorta is an alternative to resuscitative thoracotomy in non-compressible torso haemorrhage. Low-profile, compliant balloon catheter systems have been developed, which can be deployed without the need for fluoroscopy. However, concern exists for over inflation and aortic injury, especially as compliant balloon material can stretch reducing syringe feedback and limiting the effectiveness of a safety valve. An alternative material would be a semi-compliant balloon material, but its performance is unknown. The aim of this study was to compare the inflation characteristics of compliant versus semi-compliant balloon systems and to determine whether a pressure relief safety valve can be practically applied to a semi-compliant balloon catheter as a safety device. Methods This was an ex vivo study using porcine segments of thoracic aorta. The study consisted of two phases. The first phase involved intermittent inflation of six compliant balloon and six semi-compliant balloon balloons until balloon or aortic rupture. In the second phase, six semi-compliant balloons with the pressure-relief valve set at 0.45 atmospheres were inflated in the aortas until the valve release, followed by injection with additional 30 mL. Data including pressure, volume, balloon working length, diameter and circumferential stretch ratio were collected. Results At failure, mean balloon volume was almost double in compliant balloon group vs semi-compliant balloon group – 49.83 mL (±23.25) and 25.16 mL (±8.93), respectively ( p = 0.004), with 36% increase in working length in the compliant balloon group – 81.17 mm (±19.11) vs 59.49 (±4.86) for semi-compliant balloon ( p = 0.023). When plotted, the relationship pattern between volume and pressure fit a linear model for the compliant balloon, and a quadratic model for the semi-compliant balloon. Following attempted over inflation with the pressure valve, there was no change in parameters before and after attempted over inflation. Conclusions The inflation profile differs between balloon designs. In contrast to semi-compliant balloons, compliant balloons will accommodate more volume to mitigate increase in pressure. This does not completely eliminate the risk of over inflation. The inflation characteristics of the semi-compliant balloon permit pairing it with a safety valve, which could lead to a development of a safer balloon technology in the future.

scholarly journals Extra Anatomical Bypass for Common Femoral Artery Pseudoaneurysm following Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Hendrik Kruger ◽  
Jennifer Helen Couch ◽  
George Oosthuizen
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Artery Bypass ◽  
Common Femoral Artery ◽  
Haemorrhagic Shock ◽  
Balloon Occlusion ◽  
Artery Pseudoaneurysm ◽  
Postoperative Course ◽  
Delayed Complications ◽  
Endovascular Balloon Occlusion

Background: Improvements in the instrumentation and guidelines for the use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has increased the use of it as an adjunct in managing haemorrhagic shock. REBOA-related complications continue to be assessed and described. Methods: We describe a case of a femoral artery pseudoaneurysm within an infected groin wound after REBOA usage in a 25-year-old male after several bouts of sepsis and complications related to the initial penetrating injury and associated ICU stay. Results: An extra-anatomical external iliac-to-superficial femoral artery bypass was performed using a 6mm polytetrafluoroethylene graft to treat the FAP successfully. Conclusion:  REBOA is a well described adjunct in the management of haemorrhagic shock. The immediate and delayed complications should be not overlooked. Deviations from the expected postoperative course should be promptly recognised and managed by a clinician with appropriate expertise.      

scholarly journals Loop formation by an aortic occlusion balloon catheter during resuscitative endovascular balloon occlusion of the aorta (REBOA)

2019 ◽  
Vol 14 (2) ◽  
pp. 184-186
Author(s):  
Yasuyuki Onishi ◽  
Hiroyuki Kimura ◽  
Mitsunori Kanagaki ◽  
Shojiro Oka ◽  
Genki Fukumoto ◽  
...  
Keyword(s):  
Balloon Catheter ◽  
Balloon Occlusion ◽  
Aortic Occlusion ◽  
Loop Formation ◽  
Occlusion Balloon ◽  
Endovascular Balloon Occlusion ◽  
Occlusion Balloon Catheter

scholarly journals The REBOA window: a cadaveric study delineating the optimum site for austere cannulation of the femoral artery for resuscitative endovascular balloon occlusion of the aorta

2020 ◽  
pp. bmjmilitary-2019-001383
Author(s):  
Naim Slim ◽  
C T West ◽  
P Rees ◽  
C Brassett ◽  
M Gaunt
Keyword(s):  
Femoral Artery ◽  
Distal Part ◽  
Femoral Vein ◽  
Balloon Occlusion ◽  
Lower Limbs ◽  
Inguinal Ligament ◽  
Arterial Access ◽  
Femoral Vessels ◽  
Inferior Border ◽  
Endovascular Balloon Occlusion

IntroductionHaemorrhage is the major cause of early mortality following traumatic injury. Patients suffering from non-compressible torso haemorrhage are more likely to suffer early death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be effective in initial resuscitation; however, establishing swift arterial access is challenging, particularly in a severe shock. This is made more difficult by anatomical variability of the femoral vessels.MethodsThe femoral vessels were characterised in 81 cadaveric lower limbs, measuring specifically the distance from the inferior border of the inguinal ligament to the distal part of the origin of the profunda femoris artery (PFA), and from the distal part of the origin of the PFA to where the femoral vein lies posterior to and is completely overlapped by the femoral artery.ResultsThe femoral vein lay deep to the femoral artery at a mean distance of 105 mm from the inferior border of the inguinal ligament. The PFA arose from the femoral artery at a mean distance of 51.1 mm from the inguinal ligament. From the results, it is predicted that the PFA originates from the common femoral artery approximately 24 mm from the inguinal ligament, and the femoral vein is completely overlapped by the femoral artery by 67.7 mm distal from the inguinal ligament, in 95% of subjects.ConclusionsBased on the results, proposed is an ‘optimal access window’ of up to 24 mm inferior to the inguinal ligament for common femoral arterial catheterisation for pre-hospital REBOA, or more simply within one finger breadth.

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