Zone III REBOA and the COBRA-OS™: Safety of Inadvertent Iliac Artery Device Deployment

Power, Adam; Parekh, Asha; Beveridge, Tyler S.; Groh, Adam M.R.; Moore, Laura J.

doi:10.26676/jevtm.v5i2.202

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“…The issue of variable blood vessel sizes also occurs when performing balloon occlusion for proximal control in arteries other than the aorta, such as in the axillary/subclavian artery or iliac artery, before vascular repair 8. The iliac artery itself can also be iatrogenically injured during zone 3 REBOA due to migration of the balloon caudally, and the additional overinflation ability of the COBRA-OS has previously been found to help prevent this complication in an animal model 9. Further, safe overinflation may be useful in patients that are severely hypotensive when proximal and distal occlusion confirmation techniques may not be accurate and during REBOA with an overzealous inexperienced user who might inadvertently overinflate.…”

Section: Discussionmentioning

confidence: 99%

Cushioned on the way up, controlled on the way down during resuscitative endovascular balloon occlusion of the aorta (REBOA): investigating a novel compliant balloon design for optimizing safe overinflation combined with partial REBOA ability

Power

Parekh

Parry

et al. 2022

Trauma Surg Acute Care Open

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BackgroundThere are a variety of devices capable of performing resuscitative endovascular balloon occlusion of the aorta (REBOA), with most containing compliant balloon material. While compliant material is ideal for balloon inflation due to its “cushioning” effect, it can be problematic to “control” during deflation. The COBRA-OS (Control Of Bleeding, Resuscitation, Arterial Occlusion System) was designed to optimize inflation and deflation of its compliant balloon and was tested in vitro and in vivo with respect to its overinflation and partial REBOA abilities.MethodsFor overinflation, the COBRA-OS was inflated in three differently sized inner diameter (ID) vinyl tubes until balloon rupture. It was then overinflated in six harvested swine aortas and in all three REBOA zones of three anesthetized swine. For partial REBOA, the COBRA-OS underwent incremental deflation in a pulsatile benchtop aortic model and in zone 1 of three anesthetized swine.ResultsFor overinflation, compared with the known aortic rupture threshold of 4 atm, the COBRA-OS exceeded this value in only the smallest of the vinyl tubes: 8 mm ID tube, 6.5 atm; 9.5 mm ID tube, 3.5 atm; 13 mm ID tube, 1.5 atm. It also demonstrated greater than 500% overinflation ability without aortic damage in vitro and caused no aortic damage when inflated to maximum inflation volume in vivo. For partial REBOA, the COBRA-OS was able to provide a titration window of between 3 mL and 4 mL in both the pulsatile vascular model (3.4±0.12 mL) and anesthetized swine (3.8±0.35 mL).DiscussionThe COBRA-OS demonstrated the ability to have a cushioning effect during inflation combined with titration control on deflation in vitro and in vivo. This study suggests that despite its balloon compliance, both safe overinflation and partial REBOA can be successfully achieved with the COBRA-OS.Level of evidenceBasic science.

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Section: Discussionmentioning

confidence: 99%