Radiofrequency Identification of the ER-REBOA: Confirmation of Placement Without Fluoroscopy

Wessels, Lyndsey E.; Wallace, James D.; Bowie, Jason; Butler, Warren L.; Spalding, Carmen N; Krzyżaniak, Michael

doi:10.1093/milmed/usy187

Cited by 16 publications

(9 citation statements)

References 23 publications

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“…14 These would translate well into the austere environment, although misplacement may still occur. Further studies have used a slightly more advanced method placement, from radiofrequency identification scanners, 15 to ultrasound placement to confirm aortic placement. 16 While these devices would be feasible in the austere environment, the implementation would be cumbersome and would require a bulky, although portable, and potentially costly piece of equipment to accompany the device.…”

Section: Discussionmentioning

confidence: 99%

Real-time bedside management and titration of partial resuscitative endovascular balloon occlusion of the aorta without an arterial line: Good for pressure, not for flow!

Carr

Benham

Lee

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND: Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) attempts to minimize ischemia/reperfusion injury while controlling hemorrhage. There are little data on optimal methods to evaluate and titrate partial flow, which typically requires invasive arterial line monitoring. We sought to examine the use of a miniaturized handheld digital pressure device (COMPASS; Mirador Biomedical, Seattle, WA) for pREBOA placement and titration of flow. METHODS:Ten swine underwent standardized hemorrhagic shock. Carotid and iliac pressures were monitored with both arterial line and COMPASS devices, and flow was monitored by aortic and superior mesenteric artery flow probes. Partial resuscitative endovascular balloon occlusion of the aorta was inflated to control hemorrhage for 15 minutes before being deflated to try targeting aortic flow of 0.7 L/min (using only the COMPASS device) by an operator blinded to the arterial line pressures and aortic flow. Correlations between COMPASS and proximal/ distal arterial line were evaluated, as well as actual aortic flow. RESULTS:There was strong correlation between the distal mean arterial pressure (MAP) and the distal COMPASS MAP (r = 0.979, p < 0.01), as well as between the proximal arterial line and the proximal COMPASS on the pREBOA (r = 0.989, p < 0.01). There was a significant but weaker correlation between the distal compass MAP reading and aortic flow (r = 0.47, p < 0.0001), although it was not clinically significant and predicted flow was not achieved in a majority of the procedures. Of 10 pigs, survival times ranged from 10 to 120 minutes, with a mean survival of 50 minutes, and 1 pig surviving to 120 minutes. CONCLUSION: Highly reliable pressure monitoring is achieved proximally and distally without arterial lines using the COMPASS device on the pREBOA.Despite accurate readings, distal MAPs were a poor indicator of aortic flow, and titration based upon distal MAPs did not provide reliable results. Further investigation will be required to find a suitable proxy for targeting specific aortic flow levels using pREBOA.

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Section: Discussionmentioning

confidence: 99%

Real-time bedside management and titration of partial resuscitative endovascular balloon occlusion of the aorta without an arterial line: Good for pressure, not for flow!

Carr

Benham

Lee

et al. 2021

J Trauma Acute Care Surg

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“…Although it has been proposed the estimation of the catheter length positioning in zone III by torso height, the result was just passable [6]. Wessels et al tried to apply radiofrequency identi cation to predict the location of balloon in zone III on the cadaver with an accuracy of only 16% [14]. It is also recommended to assemble various individual information (gender, smoking, diabetes mellitus, etc.)…”

Section: Discussionmentioning

confidence: 99%

Location of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone III Using External Landmark Without Fluoroscopy: A CTA-based Retrospective Study

Weng¹,

Qian²,

Zhou³

et al. 2020

Preprint

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) can timely prevent the wounded from massive hemorrhage. We aim to study whether the combination of the xiphoid process and the umbilicus could guide the placement of REBOA in zone III without fluoroscopy. Methods We conducted a retrospective study in a university hospital that included 57 subjects who underwent contrast-enhanced computed tomography (CT) from April to December in 2019. External distances and intravascular lengths were measured by three-dimensional reconstruction CT images on the workstation, including the distances from the 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 (FA-mZIII), the lowest renal artery (FA-LRA), and aortic bifurcation (FA-AB). The relationship between external landmarks and REBOA catheter positioning in zone III was studied, involving the quartering distances between the xiphoid process and the umbilicus, the distance below the xiphoid process and that above the umbilicus. The predicted accuracy and safety margin of the balloon (distal and proximal) were calculated by curvature plane reconstruction. The probability of balloon positioning in zone III using these three methods was compared by Chi square test. Results The average length of aortic zone III was 9.4 cm (SD = 10.0), and that 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 significantly longer than FA-LRA, and FA-Ui was significantly shorter than FA-AB (P < 0.05). Using the quartering distances between the xiphoid and the umbilicus, the distance below the xiphoid, the distance above the umbilicus to predict the length of REBOA catheter positioning in zone III showed no statistically significant difference. Using FA-mXU to predict the accuracy of catheter positioning in zone III on the left and right sides were 84.2% and 86%. Although there was a little difference between the left side of FA-mZIII and FA-mXU, there were no statistical differences on the right side. Conclusions The midpoint between the xiphoid process and the umbilicus is a good external landmark to guide the placement of REBOA in zone III without fluoroscopy.

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“…One of the challenges of REBOA placement in the pre-hospital setting is the lack of imaging capability to confirm REBOA position prior to balloon inflation. Wessels et al recently described the experimental use of radiofrequency identification to determine REBOA placement in a perfused cadaver model 31. Ogura et al described their protocol for using ultrasound to determine REBOA catheter placement using a wire-based system in conjunction with radial arterial line monitoring 32.…”

Section: Current Reboa Datamentioning

confidence: 99%

Resuscitative endovascular balloon occlusion of the aorta: current evidence

Osborn¹,

Brenner²,

Prater³

et al. 2019

OAEM

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) has recently gained popularity as a minimally invasive alternative to open aortic cross-clamping in the management of patients with non-compressible hemorrhage arising below the diaphragm. The purpose of this review is to provide a description of the technical aspects of REBOA use along with an overview of the current animal and clinical data regarding its use.

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Radiofrequency Identification of the ER-REBOA: Confirmation of Placement Without Fluoroscopy

Abstract: Using RFID to confirm the placement of ER-REBOA is feasible with specificity highest in zone I. Future work should focus on refining this technology for the forward-deployed setting.

Cited by 16 publications

References 23 publications

Real-time bedside management and titration of partial resuscitative endovascular balloon occlusion of the aorta without an arterial line: Good for pressure, not for flow!

Real-time bedside management and titration of partial resuscitative endovascular balloon occlusion of the aorta without an arterial line: Good for pressure, not for flow!

Location of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Zone III Using External Landmark Without Fluoroscopy: A CTA-based Retrospective Study

Resuscitative endovascular balloon occlusion of the aorta: current evidence

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