From the Department of Surgery, Naval Medical Center San Diego (M.J.C., D.A.B., J.J.L., L.E.W., A.J.S., M.J.K.); and Trauma Service (R.Y.C., M.J.M.), Scripps Mercy Hospital, San Diego, California.
J Trauma Acute Care Surg. 2021 Apr 1;90(4):615-622. doi: 10.1097/TA.0000000000003059.
Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) attempts to minimize ischemia/reperfusion injury while controlling hemorrhage. There are little data on optimal methods to evaluate and titrate partial flow, which typically requires invasive arterial line monitoring. We sought to examine the use of a miniaturized handheld digital pressure device (COMPASS; Mirador Biomedical, Seattle, WA) for pREBOA placement and titration of flow.
Ten swine underwent standardized hemorrhagic shock. Carotid and iliac pressures were monitored with both arterial line and COMPASS devices, and flow was monitored by aortic and superior mesenteric artery flow probes. Partial resuscitative endovascular balloon occlusion of the aorta was inflated to control hemorrhage for 15 minutes before being deflated to try targeting aortic flow of 0.7 L/min (using only the COMPASS device) by an operator blinded to the arterial line pressures and aortic flow. Correlations between COMPASS and proximal/distal arterial line were evaluated, as well as actual aortic flow.
There was strong correlation between the distal mean arterial pressure (MAP) and the distal COMPASS MAP (r = 0.979, p < 0.01), as well as between the proximal arterial line and the proximal COMPASS on the pREBOA (r = 0.989, p < 0.01). There was a significant but weaker correlation between the distal compass MAP reading and aortic flow (r = 0.47, p < 0.0001), although it was not clinically significant and predicted flow was not achieved in a majority of the procedures. Of 10 pigs, survival times ranged from 10 to 120 minutes, with a mean survival of 50 minutes, and 1 pig surviving to 120 minutes.
Highly reliable pressure monitoring is achieved proximally and distally without arterial lines using the COMPASS device on the pREBOA. Despite accurate readings, distal MAPs were a poor indicator of aortic flow, and titration based upon distal MAPs did not provide reliable results. Further investigation will be required to find a suitable proxy for targeting specific aortic flow levels using pREBOA.
部分复苏性血管内球囊阻断主动脉术（pREBOA）试图在控制出血的同时将缺血/再灌注损伤降到最低。关于评估和调整部分血流的最佳方法的数据很少，而这通常需要进行有创的动脉线监测。我们试图检查使用小型手持数字压力设备（COMPASS；Mirador Biomedical，西雅图，WA）进行 pREBOA 放置和流量滴定的效果。
10 头猪经历了标准化的失血性休克。颈动脉和骼内动脉的压力通过动脉线和 COMPASS 设备进行监测，而通过主动脉和肠系膜上动脉流量探头监测血流。部分复苏性血管内球囊阻断主动脉术用于控制出血 15 分钟，然后再将其放气，以试图通过对动脉线压力和主动脉流量均不知情的操作者仅使用 COMPASS 设备将主动脉流量目标设定为 0.7 L/min。评估了 COMPASS 与近端/远端动脉线之间的相关性以及实际的主动脉流量。
远端平均动脉压（MAP）与远端 COMPASS MAP 之间存在很强的相关性（r = 0.979，p < 0.01），以及近端动脉线与 pREBOA 上的近端 COMPASS 之间的相关性（r = 0.989，p < 0.01）。尽管存在显著但较弱的相关性（r = 0.47，p < 0.0001），但远端 COMPASS MAP 读数与主动脉流量之间的相关性较弱，并且在大多数情况下，该方法并未达到预测的流量。10 头猪的存活时间范围为 10 至 120 分钟，平均存活时间为 50 分钟，1 头猪存活至 120 分钟。
在使用 pREBOA 时，无需动脉线即可在近端和远端实现高度可靠的压力监测。尽管读数准确，但远端 MAP 是主动脉流量的不良指标，基于远端 MAP 的滴定并未提供可靠的结果。需要进一步的研究来找到一种合适的替代方案，以实现使用 pREBOA 靶向特定的主动脉流量水平。
