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

  • Yosuke MatsumuraEmail author
  • Akiko Higashi
  • Yoshimitsu Izawa
  • Shuji Hishikawa
  • Hiroshi Kondo
  • Viktor Reva
  • Shigeto Oda
  • Junichi Matsumoto
Original Article
  • 6 Downloads

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.

Keywords

Resuscitative endovascular occlusion of the aorta REBOA Partial REBOA Degree of occlusion Balloon volume 

Notes

Acknowledgements

We appreciate Tomomasa Ttateno RT(R), Sho Kawai RT(R), Fumiharu Jimbo RT(R), Ryo Owada RT(R) for taking and processing CT images. We thank all members of the Centre for Development of Advanced Medical Technology, Jichi Medical University.

Author contributions

YM, a corresponding author, was responsible for drafting, editing, and submission of the manuscript. YM, AH, SH, and YI conducted the animal experiment and collected the data. HK, VR, SO, and JM critically appraised the manuscript. All the authors read and approved the final manuscript.

Funding

Grant-in-Aid for Research Activity Start-up, Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Number, 17H06567.

Compliance with ethical standards

Conflict of interest

Yosuke Matsumura was a Clinical Advisory Board Member at Tokai Medical Products. Other authors declare no conflict of interest.

Ethical approval

This study was conducted in an accredited animal research laboratory (Centre for Development of Advanced Medical Technology, Jichi Medical University, Tochigi, Japan). Institutional Animal Experiment Committee approval was obtained before beginning the study (authorisation number 17045-01).

Supplementary material

68_2019_1257_MOESM1_ESM.pdf (78 kb)
Supplementary file1 (PDF 78 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Emergency and Critical Care MedicineChiba University Graduate School of MedicineChuoJapan
  2. 2.Department of Emergency and Critical Care MedicineJichi Medical UniversityShimotsukeJapan
  3. 3.Department of Emergency and Critical Care MedicineSaiseikai Utsunomiya HospitalUtsunomiyaJapan
  4. 4.Center for Development of Advanced Medical TechnologyJichi Medical UniversityShimotsukeJapan
  5. 5.Department of RadiologyTeikyo University School of MedicineItabashiJapan
  6. 6.Department of War SurgeryKirov Military Medical AcademySt PetersburgRussia
  7. 7.Department of Emergency and Critical Care MedicineSt. Marianna University School of MedicineKawasakiJapan

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