The compatibility of computed tomography scanning and partial REBOA: A large animal pilot study

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a promising technique in the management of noncompressible torso hemorrhage (NCTH).1 The procedure involves the placement and inflation of a compliant balloon in the aorta, via the femoral artery.2 Aortic occlusion can be beneficial in NCTH as it increases cardiac afterload and reduces distal perfusion.3,4
The use of REBOA in clinical practice is increasing, and although precise indications have yet to be defined, most practitioners use the technique as a bridge to definitive hemorrhage control.5 However, animal data suggest that prolonged occlusion of the aorta, especially the thoracic segment, is associated with ischemia-reperfusion injury and potentially an increased risk of death.6,7
These findings have led to the description of “partial” REBOA (pREBOA), whereby the balloon is deflated slightly, allowing a degree of flow beyond the balloon.8 Both laboratory and clinical observations have suggested that this strategy may ameliorate ischemia-reperfusion injury and reduce the associated mortality.9,10
It is theoretically possible that pREBOA will also permit contrast-enhanced computed tomography (ceCT) scanning. Conventional REBOA (full occlusion) does not permit sufficient opacification of the vascular tree distal to the balloon, to allow for diagnostic quality imaging, limiting the usefulness of this investigation.11 While ceCT imaging is inappropriate for patients requiring expeditious surgery, for those who achieve relative hemodynamic stability with pREBOA, ceCT could be useful in defining injury pattern and directing the use of other hemostatic modalities such as angioembolization.
The aim of this pilot study was to assess the feasibility of ceCT in a porcine model of controlled hemorrhage, treated with pREBOA. A further aim was to assess how existing imaging protocols can be pragmatically modified to achieve diagnostic quality ceCT imaging.
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