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Original article
Resuscitative endovascular balloon occlusion of the aorta: rupture risk and implications for blind inflation
  1. Philip J Wasicek,
  2. William A Teeter,
  3. Megan L Brenner,
  4. Melanie R Hoehn,
  5. Thomas M Scalea,
  6. Jonathan J Morrison
  1. Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
  1. Correspondence to Dr Jonathan J Morrison, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD 21201, USA; jonathan.morrison{at}umm.edu

Abstract

Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a torso hemorrhage control technique. To expedite deployment, inflation is frequently performed as a blind technique with minimal imaging, which carries a theoretical risk of aortic injury. The objective of this study was to examine the relationship between balloon inflation, deformation and the risk of aortic rupture.

Methods Compliant balloon catheters were incrementally inflated in segments of cadaveric swine aorta. Serial longitudinal and circumferential measurements were recorded, along with the incidence of aortic rupture.

Results Fourteen cadaveric swine aorta segments were tested with mean (±SD) baseline aortic diameter (mm) of 14.2±3.4. Rupture occurred in three aortas. The mean baseline diameters (mm) of the aortic segments that were ruptured were significantly smaller than those that did not rupture (8.9±1.2 vs 15.6±1.9; P<0.001). The maximal circumferential stretch ratios were significantly higher in the aorta segments that ruptured compared with those that did not (1.9±0.1 vs 1.5±0.1; P<0.001). The maximal amount of balloon longitudinal deformation was 80 mm (116% longer than the intended working length).

Conclusions Inflation of aortic balloon catheters carries an inherent risk of aortic injury, which may be minimized through an understanding of the intrinsic characteristics of the aorta and compliant balloons. Smaller diameter aortic segments undergoing overinflation, particularly beyond a circumferential stretch ratio of 1.8, are at risk of aortic rupture.

Level of evidence Level II.

  • resuscitative endovascular balloon occlusion of the aorta
  • reboa
  • aortic rupture
  • arterial injury
  • blind inflation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/tsaco-2017-000141

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    Footnotes

    • Contributors PJW was involved in the acquisition of data. PJW and JJM did the analysis and interpretation of data and also drafted the manuscript. All the authors equally contributed to the study conception and design and critical revision of the manuscript.

    • Funding This study was funded in part by a grant from the Department of Defense; grant number W81XWH-16-1-0116.

    • Competing interests JJM and MLB are clinical advisory board members for Prytime Medical Inc.

    • Provenance and peer review Not commissioned; externally peer reviewed.