Automated Balloon Control in Resuscitative Endovascular Balloon Occlusion of the Aorta

McCarthy, Cormac; Kanterman, Ian; Trauzettel, Fabian; Jaeger, Herman Alexander; Goetz, Alice-Anne; Colvard, Benjamin; Swanstrom, Lee L.; Cantillon-Murphy, Pádraig

doi:10.1109/tbme.2018.2878642

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…It is frequently used in preclinical studies and in clinical practice, but there is no literature evaluating early hemostasis during this occlusion period. Several case reports and the retrospective review of Madurska et al report use of the ER-REBOA catheter to perform partial REBOA, which is at odds with animal research which reports that this is difficult, 15 impractical, 28 or not possible 31 without the use of a computer-controlled precision inflation device. However, at least one study reports use of a commercial, rotational inflator.…”

Section: Discussionmentioning

confidence: 99%

“…Others focus on the comparison between balloon inflation volume or pressure and distal flow or pressure, 17,22,25,34 use of computerized controllers to achieve precision control, 23,28,29 or the use of partial REBOA as a technique to enable contrast-enhanced computerized tomography diagnostic imaging. 35 It is worth noting that many of the dependent variables in these articles are relevant only to the device used, and care is warranted when considering the generalizability of this work.…”

Section: Preclinical Partial Reboa Researchmentioning

confidence: 99%

“…In this review, two studies included euvolemic animals treated with REBOA as controls. 17,25 A majority of the remainder included only controlled hemorrhage, with severity of hemorrhage ranging widely including variables between 10% and 40% estimated blood volume, 36 25%, 23,27,31,37 35%, 33 40% 17,28,30,35 of estimated blood volume. Two studies report partial REBOA with a goal of proximal SBP: 50 mmHg 32 or 90 mmHg.…”

Section: Preclinical Partial Reboa Researchmentioning

confidence: 99%

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Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Russo

White

Baer

2021

Journal of Surgical Research

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Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become a standard adjunct for the management of life-threatening truncal hemorrhage, but the technique is limited by the sequalae of ischemia distal to occlusion. Partial REBOA addresses this limitation, and the recent Food and Drug Administration approval of a device designed to enable partial REBOA will broaden its application. We conducted a systematic review of the available animal and clinical literature on the methods, impacts, and outcomes associated with partial REBOA as a technique to enable targeted proximal perfusion and limit distal ischemic injury. We hypothesize that a systematic review of the published animal and human literature on partial REBOA will provide actionable insight for the use of partial REBOA in the context of future wider clinical implementation of this technique.Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, we conducted a search of the available literature which used partial inflation of a REBOA balloon catheter. Findings from 22 large animal studies and 14 clinical studies met inclusion criteria.Results: Animal and clinical results support the benefits of partial REBOA including extending the resuscitative window extended safe occlusion time, improved survival, reduced proximal hypertension, and reduced resuscitation requirements. Clinical studies provide practical physiologic targets for partial REBOA including a period of total occlusion followed by gradual balloon deflation to achieve a target proximal pressure and/or target distal pressure.Conclusions: Partial REBOA has several benefits which have been observed in animal and clinical studies, most notably reduced ischemic insult to tissues distal to occlusion and improved outcomes compared with total occlusion. Practical clinical protocols are available for the implementation of partial REBOA in cases of life-threatening torso hemorrhage.

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Section: Discussionmentioning

confidence: 99%

Section: Preclinical Partial Reboa Researchmentioning

confidence: 99%

Section: Preclinical Partial Reboa Researchmentioning

confidence: 99%

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Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Russo

White

Baer

2021

Journal of Surgical Research

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“…86 Building on this idea, other iterations provide computer-controlled, dynamic IABO balloon adjustment in response to changes in the patient's vital signs without the need for extracorporeal circuits or additional cannulation sites. 87 In an austere environment where there are limited providers, an automated device could allow for hemorrhage control via REBOA while freeing up a provider for other pressing needs. This could prove critical in a situation with multiple casualties or in a patient with multiple injuries requiring multiple interventions.…”

Section: Novel Technology To Facilitate Reboa Use In the Austere Envi...mentioning

confidence: 99%

“…As a proof of concept, this circuit was able to maintain a proximal MAP of >60 mm Hg in animals with a liver injury during 70 minutes of REBOA with adjustments in flow based on proximal MAP 86 . Building on this idea, other iterations provide computer-controlled, dynamic IABO balloon adjustment in response to changes in the patient’s vital signs without the need for extracorporeal circuits or additional cannulation sites 87 . In an austere environment where there are limited providers, an automated device could allow for hemorrhage control via REBOA while freeing up a provider for other pressing needs.…”

Section: Novel Technology To Facilitate Reboa Use In the Austere Envi...mentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Stokes

Theodorou

Zakaluzny

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Noncompressible torso hemorrhage is a leading cause of preventable death on the battlefield. Intra-aortic balloon occlusion was first used in combat in the 1950s, but military use was rare before Operation Iraqi Freedom and Operation Enduring Freedom. During these wars, the combination of an increasing number of deployed vascular surgeons and a significant rise in deaths from hemorrhage resulted in novel adaptations of resuscitative endovascular balloon occlusion of the aorta (REBOA) technology, increasing its potential application in combat. We describe the background of REBOA development in response to a need for minimally invasive intervention for hemorrhage control and provide a detailed review of all published cases (n = 47) of REBOA use for combat casualties. The current limitations of REBOA are described, including distal ischemia and reperfusion injury, as well as ongoing research efforts to adapt REBOA for prolonged use in the austere setting.

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Safe balloon inflation parameters for resuscitative endovascular balloon occlusion of the aorta

Maleckis¹,

Keiser²,

Jadidi³

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Noncompressible hemorrhage is a leading cause of preventable death in civilian and military trauma populations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising method for controlling noncompressible hemorrhage, but safe balloon inflation parameters are not well defined. Our goal was to determine the balloon inflation parameters associated with benchtop flow occlusion and aortic/balloon rupture in ex vivo human aortas and test the hypothesis that optimal balloon inflation characteristics depend on systolic pressure and subject demographics. METHODS:Aortic occlusion parameters in human thoracic aortas (TAs) and abdominal aortas (AAs) from 79 tissue donors (median ± SD age, 52 ± 18 years [range, 13-75 years]; male, 52; female, 27) were recorded under 100/40, 150/40, and 200/40 mm Hg flow pressures for ER-REBOA and Coda balloons. Rupture tests were done with Coda balloons only without flow. RESULTS:In the TA, the average balloon inflation volumes and pressures resulting in 100/40 mm Hg flow occlusion were 11.7 ± 3.8 mL and 174 ± 65 mm Hg for the ER-REBOA, and 10.6 ± 4.3 mL and 94 ± 57 mm Hg for the Coda balloons. In the AA, these values were 6.2 ± 2.6 mL and 110 ± 47 mm Hg for the ER-REBOA, and 5.9 ± 2.2 mL and 71 ± 30 mm Hg for the Coda. The average balloon inflation parameters associated with aortic/Coda balloon rupture were 39.1 ± 6.5 mL and 1,284 ± 385 mm Hg in the TA, and 27.7 ± 7.7 mL and 1,410 ± 483 mm Hg in the AA. Age, sex, and systolic pressure all had significant effects on balloon occlusion and rupture parameters. CONCLUSION: Optimal balloon inflation parameters depend on anatomical, physiological, and demographic characteristics. Pressure-guided rather than volume-guided balloon inflation may reduce the risk of aortic rupture. These results can be used to help improve the safety of REBOA procedures and devices.

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Automated Balloon Control in Resuscitative Endovascular Balloon Occlusion of the Aorta

Cited by 3 publications

References 12 publications

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta: A Systematic Review of the Preclinical and Clinical Literature

Resuscitative endovascular balloon occlusion of the aorta in combat casualties: The past, present, and future

Safe balloon inflation parameters for resuscitative endovascular balloon occlusion of the aorta

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