May 18, 2016
BACKGROUND
• Resuscitative endovascular balloon occlusion of the aorta
(REBOA) catheter has emerged as a treatment option for
critically injured patients presenting with imminent cardiac
arrest due to hemorrhagic shock
BACKGROUND
• This balloon occlusion of the thoracic aorta can theoretically
mitigate downstream blood loss while facilitating coronary and
brain perfusion
BACKGROUND
• Placement under fluoroscopic guidance
• Postplacement x-ray for confirmation of balloon location after
blind insertion
BACKGROUND
• Surface measurements may allow individualized estimation of
the intravascular distance for safe balloon deployment
• The initial placement is important as overinsertion risks
cerebral ischemia, whereas not advancing far enough will
potentially decrease the efficacy of haemorrhage control
BACKGROUND
• To date, no human surface landmark-guided placement studies
have been performed
• We used a human cadaver model to determine which external
surface landmark was most reliable for guiding the blind
insertion of the REBOA catheter
METHODS
• A convenience sample of cadavers at the Los Angeles County-University
of Southern California Fresh Tissue Dissection Laboratory were included
in the study
• July 2013 to June 2014
METHODS
• Age, sex, height, weight, and body mass index (BMI) were documented
• Any cadaver with previous femoral vascular instrumentation or
thoracotomy or laparotomy was excluded
METHODS
• Standard Cook CODA balloon catheter
• The catheter is 120 cm long, whereas the balloon
itself is 4 cm long, with the distal balloon edge
located 2 cm from the tip of the catheter
METHODS
• External surface measurements
• Sternal notch
• Xiphoid
• Umbilicus
• Common femoral artery puncture sites
• External distances measured were from sternal notch, xiphoid, and
umbilicus to bilateral puncture sites
METHODS
• Intravascular measurements
• Distance from common femoral artery puncture sites to the aortic
bifurcation, most inferior renal artery, superior mesenteric artery, celiac
trunk and left subclavian artery take off
METHODS
• REBOA landing zone was defined as the area between the left subclavian
artery take off and celiac trunk
RESULTS
DISCUSSION
• First human cadaver–based study
• Reliable method of REBOA catheter placement without the use of
fluoroscopic guidance
• Using direct measurement of external landmarks
• As the aim of REBOA placement was to decrease blood loss from any
injuries below the diaphragm, aortic Zone 1 was the target
DISCUSSION
• Our study had several limitations
• Mean age of cadavers was higher than that of typical trauma patient
• Changes in aortic morphology over time may alter how these results
are translated into a younger patient
• BMI was consistently low
• Obesity may artificially lengthen the estimated distance
CONCLUSION
• Using the mid-sternum as an external landmark for REBOA balloon
placement
• Likelihood of the REBOA balloon to be within the landing zone is 100%
• This may facilitate emergent placement of the REBOA catheter when
imaging is not available
• Further clinical studies are warranted to apply the results of this study in
the clinical setting