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Ultrasound assessment is useful for evaluating balloon volume of resuscitative endovascular balloon occlusion of the aorta

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

Abstract

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

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

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

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.

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Data availability

The data that support the findings of this study are available from the corresponding author, YM, upon reasonable request.

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Funding

This study was supported in part by ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives), 2021–2022.

Author information

Authors and Affiliations

  1. Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan

    Makoto Aoki

  2. Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan

    Yosuke Matsumura

  3. Department of Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan

    Yoshimitsu Izawa

  4. Department of Emergency and Critical Care Medicine, Japan Red Cross Narita Hospital, Narita, Japan

    Yosuke Hayashi

Authors
  1. Makoto Aoki
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  2. Yosuke Matsumura
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  3. Yoshimitsu Izawa
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  4. Yosuke Hayashi
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Contributions

Corresponding author YM. Study concept, design MA, YM, YI. Data collection and analysis: MA, YM, YI, YH. Writing: MA, YM. Critical revision: YM, YI, YH.

Corresponding author

Correspondence to Yosuke Matsumura.

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Conflict of interest

No conflicts are declared.

Ethical approval and consent to participate

All procedures were approved by the Centre for Development of Advanced Medical Technology from Jichi Medical University.

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Aoki, M., Matsumura, Y., Izawa, Y. et al. Ultrasound assessment is useful for evaluating balloon volume of resuscitative endovascular balloon occlusion of the aorta. Eur J Trauma Emerg Surg 49, 2479–2484 (2023). https://doi.org/10.1007/s00068-023-02309-6

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  • DOI: https://doi.org/10.1007/s00068-023-02309-6

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