scholarly journals Pediatric Sized REBOA Catheter Testing in a Pulsatile Aortic Flow Model

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Erik Scott DeSoucy ◽  
Alfred Francois Trappey ◽  
Anders J Davidson ◽  
Joseph J Dubose ◽  
Timothy K Williams ◽  
...  
Keyword(s):  
Pulsatile Flow ◽  
Flow Model ◽  
Balloon Occlusion ◽  
Aortic Flow ◽  
Future Research ◽  
Aortic Blood Flow ◽  
Inflated Balloon ◽  
Balloon Catheters ◽  
Pelvic Hemorrhage ◽  
Distal Migration

Background – Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of pediatric abdomino-pelvic hemorrhage from trauma or iatrogenic injury is limited by a lack of appropriately sized balloon catheters that can be delivered through less than a 7 French sheath. Methods – We bench tested the occlusion capability of eight commercially available balloon catheters deliverable through 4Fr, 5Fr and 6Fr sheaths in an anatomic pulsatile flow model of the pediatric aorta with variable luminal diameters (5mm, 6mm, 7mm, 8mm, 9mm, 10mm, and 12mm). Inflated balloon migration and the deflated balloon’s effect on aortic flow were recorded. The flow chamber was calibrated to approximate size-appropriate physiologic aortic blood flow. Results – Seven of eight devices were able to occlude the test lumen diameter corresponding to their manufacture specifications. Deflated luminal flow restriction in the smallest test lumen was lowest in the Fogarty devices (0-3%) followed by Cordis (8-10%) and Numed (14-26%) devices. The Fogarty devices demonstrated the most distal migration (10-15mm) followed by Numed (1-5mm). Device migration was undetectable in the Cordis devices.   Conclusion – There are commercially available balloon catheters, deliverable through smaller than 7Fr sheaths which can occlude pediatric sized aortic test lumens in the setting of physiologic pulsatile flow. These results will help inform future research, device development and practice in the field of pediatric REBOA.

A Study of Doppler Waveform Using Pulsatile Flow Model

1997 ◽  
Vol 37 (2) ◽  
pp. 225 ◽  
Author(s):  
Hye Won Chung ◽  
Myung Jin Chung ◽  
Jae Hyung Park ◽  
Jin Wook Chung ◽  
Dong Hyuk Lee ◽  
...  
Keyword(s):  
Pulsatile Flow ◽  
Flow Model ◽  
Doppler Waveform

Resuscitative endovascular balloon occlusion of the aorta (REBOA) enables operative management of the peripartum trauma patient in hemorrhagic shock

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Kelvin Allenson ◽  
Laura Moore
Keyword(s):  
Maternal Death ◽  
Motor Vehicle ◽  
Operative Management ◽  
Balloon Occlusion ◽  
Motor Vehicle Accidents ◽  
Gravid Uterus ◽  
Intrauterine Pregnancy ◽  
Vehicle Accidents ◽  
Pelvic Hemorrhage ◽  
Endovascular Balloon Occlusion

Trauma related injury is the leading cause of non-obstetric maternal death.  The gravid uterus is at risk for injury, particularly during motor vehicle accidents.  Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a means of controlling pelvic hemorrhage in the setting of trauma.  We report the use of REBOA in a hemodynamically unstable, multiply-injured young woman with viable intrauterine pregnancy.

Effect of abdominal aortic endoprostheses on arterial pulse wave velocity in an in vitro abdominal aortic flow model

2018 ◽  
Vol 39 (10) ◽  
pp. 104001 ◽  
Author(s):  
Kim van Noort ◽  
Suzanne Holewijn ◽  
Richte C L Schuurmann ◽  
Johannes T Boersen ◽  
Simon P Overeem ◽  
...  
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Flow Model ◽  
Pulse Wave ◽  
Aortic Flow ◽  
Arterial Pulse ◽  
Arterial Pulse Wave ◽  
Abdominal Aortic ◽  
Arterial Pulse Wave Velocity

scholarly journals Successfully REBOA performance: does medical specialty matter? International data from the ABOTrauma Registry

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Peter Hilbert-Carius ◽  
◽  
David McGreevy ◽  
Fikri M. Abu-Zidan ◽  
Tal M. Hörer
Keyword(s):  
Injury Severity ◽  
Invasive Procedure ◽  
Balloon Occlusion ◽  
High Rate ◽  
Future Research ◽  
Trauma Patients ◽  
Anatomic Landmarks ◽  
Access Methods ◽  
Angiography Suite ◽  
Aortic Balloon Occlusion

Abstract Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive procedure being increasingly utilized to prevent patients with non-compressible torso hemorrhage from exsanguination. The increased use of REBOA is giving rise to discussion about “Who is and who should be performing it?” Methods Data from the international ABO (aortic balloon occlusion) Trauma Registry from between November 2014 and April 2020 were analyzed concerning the question: By who, how, and where is REBOA being performed? The registry collects retrospective and prospective data concerning use of REBOA in trauma patients. Results During the study period, 259 patients had been recorded in the registry, 72.5% (n = 188) were males with a median (range) age of 46 (10-96) years. REBOA was performed in the ER in 50.5%, in the OR in 41.5%, and in the angiography suite in 8% of patients. In 54% of the patients REBOA was performed by surgeons (trauma surgeons 28%, vascular surgeons 22%, general surgeons 4%) and in 46% of the patients by non-surgeons (emergency physicians 31%, radiologists 9.5%, anesthetists 5.5%). Common femoral artery (CFA) access was achieved by use of external anatomic landmarks and palpation alone in 119 patients (51%), by cutdown in 57 patients (24%), using ultrasound in 49 patients (21%), and by fluoroscopy in 9 patients (4%). Significant differences between surgeons and non-surgeons were found regarding patient’s age, injury severity, access methods, place where REBOA was performed, location patients were taken to from the emergency room, and mortality. Conclusion A substantial number of both surgical and non-surgical medical disciplines are successfully performing REBOA to an almost equal extent. Surgical cutdown is used less frequently as access to the CFA compared with reports in older literature and puncture by use of external anatomic landmarks and palpation alone is used with a high rate of success. Instead of discussing “Who should be performing REBOA?” future research should focus on “Which patient benefits most from REBOA?”

Description of LV pressure-volume relations by time-varying elastance and source resistance

1987 ◽  
Vol 253 (1) ◽  
pp. H83-H90 ◽  
Author(s):  
W. C. Little ◽  
G. L. Freeman
Keyword(s):  
Left Ventricle ◽  
Balloon Occlusion ◽  
Ascending Aorta ◽  
Aortic Flow ◽  
Three Dimensions ◽  
Time Varying ◽  
Source Resistance ◽  
Lv Volume ◽  
Definition Of ◽  
Inotropic Stimulation

If the left ventricle (LV) behaves as a time-varying elastance [E(t)] that is independent of load, then definition of E(t) during normal ejecting beats should permit accurate prediction of LV pressure (LVP) during a maximally afterloaded (isovolumic) beat. We tested this hypothesis in six dogs preinstrumented to measure LVP and aortic flow (Q) and to determine LV volume (V) from three dimensions. LVP and V were varied by caval occlusions. These data were used to determine E(t) and minimal volume required to generate pressure (Vo) at 10-ms intervals during systole using a simple E(t) model, P(t) = E(t) [V(t)-Vo], where P(t) is LVP at any time after the onset of contraction, and V(t) is the LV volume at t. LVP was measured during isovolumic beats generated by sudden balloon occlusion of the ascending aorta. The simple E(t) model accurately predicted isovolumic LVP during the first 70 ms of systole (r = 0.99) and also the end-systolic LVP but underestimated LVP during midsystole by 48 +/- 5 (SD) mmHg (P less than 0.05). When a pressure-dependent source resistance (K = 0.0015 s/ml) was added to the model to reduce LVP in proportion to Q, such that P(t) = E(t) [V(t)-Vo] X [1 - KQ]), LVP during the isovolumic beat was accurately predicted throughout systole (r = 0.99). However, the time to develop peak isovolumic pressure was 22 +/- 7 ms less than predicted. Similar results were obtained during inotropic stimulation with dobutamine in five animals.

Sign in / Sign up

Export Citation Format

Share Document