Position of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in Thai People
Keywords:
REBOA; Abdominal hemorrhage; Resuscitation; Shock; TraumaAbstract
Background and Objective: Major cause of trauma death worldwide is from non-compressible torso hemorrhage. Currently, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) plays role in control of intraabdominal bleeding. Therefore, it is necessary to use several methods to confirm the position of the balloon precisely, such as fluoroscopy. But most hospitals in Thailand do not support fluoroscopic machine in ER. This study aimed to determine the intravascular length for placement REBOA and compare to the appropriate locations of external landmarks of the body.
Method: Human cadaveric study, external anatomical (sternal notch, xyphoid process and umbilicus) and intravascular (left subclavian artery (LSA), celiac trunk (CT), lowest renal artery (LRA) and aortic bifurcation (AB)) landmarks from puncture sites. The landing zones were calculated with intravascular landmarks.
Results: Twenty-two cadavers were analyzed. Mean external landmarks from right groin to umbilicus, xyphoid, sternal notchere 19.20, 32.26, 53.42 cm. and from left groin were 19.25, 32.62, 53.65 cm. The mean intravascular distance from right puncture site to AB, LRA, CT, LSA were 21.37, 30.47, 33.95, 55.97 cm. and from left puncture site were 20.69, 29.72, 32.87, 56.20 cm. There are statistically significant of clinical correlations between external and intravascular length of right groin - umbilicus with right puncture site - AB (p=0.0385) and right groin - sternal notch with right puncture site - LSA root (p=0.303).
Conclusion: The use of external anatomical landmarks to estimate length of REBOA in Zone-1 and Zone-3 with evaluate the clinical response is safe to perform the procedure.
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