Abstract text (incl. references and figure legends)
Introduction: In fluoroscopy-free settings, alternative safe and quick methods for placing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and Resuscitative Endovascular Balloon Occlusion of the Inferior Vena Cava (REBOVC) are needed. Ultrasound (US) is being increasingly used to guide the placement of REBOA in the absence of fluoroscopy (FL). Our hypothesis was that US could be used to adequately visualize and guide REBOVC positioning, without significant time-delay, when compared to FL guidance.
Material and Methods: Ten anesthetized pigs were used to compare US-guided placement of supracoeliac REBOA and suprahepatic REBOVC with corresponding FL- guidance. Accuracy was controlled by FL. Four intervention groups: 1) FL REBOA 2) FL REBOVC 3) US REBOA and 4) US REBOVC were used. The aim was to carry out the four interventions in all animals. Randomization was performed to either FL or US guidance first. Time to position the balloons in the supracoeliac aorta or in the suprahepatic inferior vena cava was recorded and compared between the four intervention groups.
Results: US-guided REBOA and REBOVC placement was completed in eight animals, respectively. All eight had correctly positioned REBOA and REBOVC on FL verification. FL-guided REBOA placement was slightly faster (median 14 sec, IQR 13-17 sec) than US-guided REBOA (median 22 sec, IQR 21-25 sec, p=0.024). The corresponding comparisons of the REBOVC groups were not statistically significant, with FL-guided REBOVC taking 19 seconds, median, (IQR 11-22 sec) and US-guided REBOVC taking 27 sec, median, (IQR 20-34 sec, p=0.19).
Conclusions: US adequately and quickly guide the placement of supracoeliac REBOA and suprahepatic REBOVC in a porcine laboratory model.
References: Wikström MB et al. A randomized porcine study of the hemodynamic and metabolic effects of combined endovascular occlusion of the vena cava and the aorta in normovolemia and in hemorrhagic shock. J Trauma Acute Care Surg. 2021.
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