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3 Safely landing a resuscitative endovascular balloon occlusion of the aorta (REBOA) device in zone one
  1. O Jefferson and
  2. JJ Morrison
  1. Emergency Department, St Mary’s Hospital, London, UK

Abstract

Background Non-compressible torso haemorrhage is a leading cause of potentially preventable death following trauma. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a technique to temporise haemorrhage. Areas for potential inflation have been characterised as zones I – III. Placement superior to zone I may cause harm. Fluoroscopy, used to confirm position, is often unavailable. The literature shows disagreement about whether a fixed insertion distance would be safe. Some papers advocate using a multi-variable insertion formula.

Methods Three cohorts of patients underwent retrospective analysis of their aortic morphometry. The patients had undergone CT imaging of their torsos when they presented to one of three centres following serious traumatic injury. Aortic reconstructions were performed and measurements taken. Virtual balloons were inserted to both fixed distances and distances calculated using previously reported formulae.

Results The study population consisted of trauma patients presenting to Camp Bastion, Afghanistan [n=177]; St Mary’s Hospital, London, UK [n=100]; Wilford Hall Hospital, Texas, US [n=88]. When compared, the 3 cohorts were sufficiently similar for combined analysis (n=365). The two fixed insertion distances (444 mm and 418 mm) each conveyed virtual balloon placement accuracies of 98.4% (359/365). The placements proximal to Zone I occurred in those patients with the smallest 2% of torso heights. The 2 formulae for calculating zone I insertion length each conveyed accuracy of 99.7% (364/365). Statistical analysis found no significant difference between formulaic and fixed insertion distance accuracies (p=0.07).

Conclusion Fixed distance insertion is more practical in an emergency situation; formulae conveyed no greater accuracy. Fixed distances may not suit a minority of patients who are in the extreme of a population’s height range. These findings support the trial of a zone I fixed distance insertion algorithm.

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