PMID- 31696263
OWN - NLM
STAT- MEDLINE
DCOM- 20211015
LR  - 20211015
IS  - 1863-9941 (Electronic)
IS  - 1863-9933 (Linking)
VI  - 47
IP  - 4
DP  - 2021 Aug
TI  - Distal pressure monitoring and titration with percent balloon volume: feasible 
      management of partial resuscitative endovascular balloon occlusion of the aorta 
      (P-REBOA).
PG  - 1023-1029
LID - 10.1007/s00068-019-01257-4 [doi]
AB  - INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) 
      increases proximal arterial pressure, but may also induce life-threatening distal 
      ischemia. Partial REBOA (P-REBOA) is thought to mitigate distal ischemia during 
      aortic occlusion. However, feasible indicators of the degree of P-REBOA remain 
      inconsistent. We hypothesised percent balloon volume could be a substitute for 
      pressure measurements of gradients during P- REBOA. This study aimed to compare 
      balloon volume and arterial pressure gradient, and analysed with intra-balloon 
      pressure and balloon shape. METHODS: Proximal (carotid) and distal (femoral) 
      arterial pressures were recorded and a 7-Fr REBOA catheter was placed in four 
      swine. Total REBOA was defined as a cessation of distal pulse pressure and 
      maximum balloon volume was documented. The balloon volume was titrated by 20% 
      increments of maximum capacity to adjust the degree of P-REBOA. The 
      distal/proximal arterial pressure gradient and the intra-balloon pressures were 
      also recorded. The changes in shape and the cross-sectional area of the balloon 
      were evaluated with computed tomography (CT) images. RESULTS: The proximal mean 
      arterial pressure (MAP) plateaued after 60% balloon volume; meanwhile, distal 
      pulse pressure was still left. The balloon pressure was traced with proximal MAP 
      before contact with aortic wall. The balloon shape changed unevenly from "cone" 
      to "spindle" shape, although the balloon cross-sectional area of the mid-segment 
      linearly increased. CONCLUSION: Monitoring distal pressure and titrating percent 
      balloon volume is feasible to manage P-REBOA. In this experiment, 60% balloon 
      volume was enough inflation to elevate central pressure allowing distal 
      perfusion. The intra-balloon pressure was not reliable due to the strong 
      influence of proximal MAP and uneven change of the balloon shape.
CI  - (c) 2019. Springer-Verlag GmbH Germany, part of Springer Nature.
FAU - Matsumura, Yosuke
AU  - Matsumura Y
AUID- ORCID: 0000-0003-4830-3791
AD  - Department of Emergency and Critical Care Medicine, Chiba University Graduate 
      School of Medicine, 1-8-1 Inohana, Chuo, 260-8677, Chiba, Japan. 
      yousuke.jpn4035@gmail.com.
FAU - Higashi, Akiko
AU  - Higashi A
AD  - Department of Emergency and Critical Care Medicine, Chiba University Graduate 
      School of Medicine, 1-8-1 Inohana, Chuo, 260-8677, Chiba, Japan.
FAU - Izawa, Yoshimitsu
AU  - Izawa Y
AD  - Department of Emergency and Critical Care Medicine, Jichi Medical University, 
      Shimotsuke, 329-0498, Japan.
AD  - Department of Emergency and Critical Care Medicine, Saiseikai Utsunomiya 
      Hospital, Utsunomiya, 321-0974, Japan.
FAU - Hishikawa, Shuji
AU  - Hishikawa S
AD  - Center for Development of Advanced Medical Technology, Jichi Medical University, 
      Shimotsuke, 329-0498, Japan.
FAU - Kondo, Hiroshi
AU  - Kondo H
AD  - Department of Radiology, Teikyo University School of Medicine, Itabashi, Japan.
FAU - Reva, Viktor
AU  - Reva V
AD  - Department of War Surgery, Kirov Military Medical Academy, St Petersburg, Russia.
FAU - Oda, Shigeto
AU  - Oda S
AD  - Department of Emergency and Critical Care Medicine, Chiba University Graduate 
      School of Medicine, 1-8-1 Inohana, Chuo, 260-8677, Chiba, Japan.
FAU - Matsumoto, Junichi
AU  - Matsumoto J
AD  - Department of Emergency and Critical Care Medicine, St. Marianna University 
      School of Medicine, Kawasaki, 216-8511, Japan.
LA  - eng
GR  - 17H06567/Japan Society for the Promotion of Science/
PT  - Journal Article
DEP - 20191106
PL  - Germany
TA  - Eur J Trauma Emerg Surg
JT  - European journal of trauma and emergency surgery : official publication of the 
      European Trauma Society
JID - 101313350
SB  - IM
MH  - Animals
MH  - Aorta
MH  - *Balloon Occlusion
MH  - Disease Models, Animal
MH  - *Endovascular Procedures
MH  - Resuscitation
MH  - *Shock, Hemorrhagic/therapy
MH  - Swine
OTO - NOTNLM
OT  - Balloon volume
OT  - Degree of occlusion
OT  - Partial REBOA
OT  - REBOA
OT  - Resuscitative endovascular occlusion of the aorta
EDAT- 2019/11/07 06:00
MHDA- 2021/10/16 06:00
CRDT- 2019/11/08 06:00
PHST- 2019/05/08 00:00 [received]
PHST- 2019/10/25 00:00 [accepted]
PHST- 2019/11/07 06:00 [pubmed]
PHST- 2021/10/16 06:00 [medline]
PHST- 2019/11/08 06:00 [entrez]
AID - 10.1007/s00068-019-01257-4 [pii]
AID - 10.1007/s00068-019-01257-4 [doi]
PST - ppublish
SO  - Eur J Trauma Emerg Surg. 2021 Aug;47(4):1023-1029. doi: 
      10.1007/s00068-019-01257-4. Epub 2019 Nov 6.