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A new method using surface landmarks to locate resuscitative endovascular balloon occlusion of the aorta based on a retrospective CTA study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) can timely prevent the wounded from fatal hemorrhage. However, blind insertion of REBOA in field or emergency room may result in catheter malposition and serious complications. We aim to develop a new method based on surface landmarks to guide the accurate placement of REBOA in zone III of aorta without fluoroscopy.

Methods

A retrospective study was conducted in a university hospital, including 57 subjects who underwent computed tomography angiography (CTA) from April to December in 2019. External distances and intravascular lengths were measured by three-dimensional reconstruction of CT images, including the distances from the insertion site of femoral artery to the xiphoid process (FA-Xi), the midpoint between the xiphoid process and the umbilicus (FA-mXU), the umbilicus (FA-Ui), the midpoint of the zone III of aorta (FA-mZIII), the lowest renal artery (FA-LRA), and aortic bifurcation (FA-AB). The distal and proximal ideal margin and predicted accuracy were calculated by curvature plane reconstruction. The predicted probability of balloon positioning in zone III by different methods was compared.

Results

The mean age of all patients was 60 years (SD = 9.4). The average length of zone III of aorta was 9.4 cm (SD = 1.0), and the length of FA-mZIII on the right and left sides were 24.4 cm (SD = 2.1), 23.8 cm (SD = 2.1), respectively. FA-Xi was longer than FA-LRA, and FA-Ui was shorter than FA-AB (paired two-tailed test, p < 0.001). Using three methods including the optimal quartering distances, the optimal distances below the xiphoid and above the umbilicus to predict the length of REBOA catheter positioning in zone III showed no statistically significant difference. The predicted accuracy of catheter positioning in zone III on the left and right sides guided by FA-mXU were 84.2% and 86%.

Conclusions

The midpoint between the xiphoid process and the umbilicus may be a new surface landmark for people of normal weight to guide rapid positioning REBOA in zone III of aorta without fluoroscopy.

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Availability of data and material

All the data are available and will be submitted if required.

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Abbreviations

REBOA:

Resuscitative endovascular balloon occlusion of the aorta

CTA:

Computed tomography angiography

FA:

Femoral artery

Xi:

Xiphoid process

mXU:

The midpoint between the xiphoid process and the umbilicus

Ui:

Umbilicus

mZIII:

The midpoint of the zone III

BMI:

Body mass index

LRA:

Lowest renal artery

AB:

Aortic bifurcation

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Funding

Mao Zhang is funded by the Key Program Co-sponsored by Zhejiang Province and National Health Commission of China (2018271879) and the Key Research Project of Zhejiang Province (2021C03073). Anyu Qian is funded by the Welfare Scientific Research Project of Zhejiang Province (LGD19H150003). These agencies provided financial support but were not involved in any other aspect of the research.

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Authors and Affiliations

  1. Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang road, Hangzhou, 310009, China

    Danlei Weng, Anyu Qian, Qijing Zhou, Jiefeng Xu, Shanxiang Xu & Mao Zhang

  2. Institute of Emergency Medicine, Zhejiang University, Hangzhou, 310009, China

    Danlei Weng, Anyu Qian, Jiefeng Xu, Shanxiang Xu & Mao Zhang

  3. Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China

    Qijing Zhou

Authors
  1. Danlei Weng
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  2. Anyu Qian
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  3. Qijing Zhou
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  4. Jiefeng Xu
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  5. Shanxiang Xu
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  6. Mao Zhang
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Contributions

The corresponding author (MZ and SX) was in charge of study design and data analysis. The first author (DW) was responsible for data collection, manuscript writing and cooperated with the rest three authors (AQ, QZ, and JX) in data analysis and correction work. All authors participated in the critical revision of the manuscript, and all authors approved the final version to be submitted.

Corresponding authors

Correspondence to Shanxiang Xu or Mao Zhang.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This retrospective study was approved by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (approval number: 2019380).

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Weng, D., Qian, A., Zhou, Q. et al. A new method using surface landmarks to locate resuscitative endovascular balloon occlusion of the aorta based on a retrospective CTA study. Eur J Trauma Emerg Surg 48, 1945–1953 (2022). https://doi.org/10.1007/s00068-021-01686-0

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  • DOI: https://doi.org/10.1007/s00068-021-01686-0

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