Power Adam, Parekh Asha, Parry Neil, Moore Laura J
Surgery, Western University, London, Ontario, Canada.
Engineering, Western University, London, Ontario, Canada.
Trauma Surg Acute Care Open. 2022 Jul 14;7(1):e000948. doi: 10.1136/tsaco-2022-000948. eCollection 2022.
There are a variety of devices capable of performing resuscitative endovascular balloon occlusion of the aorta (REBOA), with most containing compliant balloon material. While compliant material is ideal for balloon inflation due to its "cushioning" effect, it can be problematic to "control" during deflation. The COBRA-OS (Control Of Bleeding, Resuscitation, Arterial Occlusion System) was designed to optimize inflation and deflation of its compliant balloon and was tested in vitro and in vivo with respect to its overinflation and partial REBOA abilities.
For overinflation, the COBRA-OS was inflated in three differently sized inner diameter (ID) vinyl tubes until balloon rupture. It was then overinflated in six harvested swine aortas and in all three REBOA zones of three anesthetized swine. For partial REBOA, the COBRA-OS underwent incremental deflation in a pulsatile benchtop aortic model and in zone 1 of three anesthetized swine.
For overinflation, compared with the known aortic rupture threshold of 4 atm, the COBRA-OS exceeded this value in only the smallest of the vinyl tubes: 8 mm ID tube, 6.5 atm; 9.5 mm ID tube, 3.5 atm; 13 mm ID tube, 1.5 atm. It also demonstrated greater than 500% overinflation ability without aortic damage in vitro and caused no aortic damage when inflated to maximum inflation volume in vivo. For partial REBOA, the COBRA-OS was able to provide a titration window of between 3 mL and 4 mL in both the pulsatile vascular model (3.4±0.12 mL) and anesthetized swine (3.8±0.35 mL).
The COBRA-OS demonstrated the ability to have a cushioning effect during inflation combined with titration control on deflation in vitro and in vivo. This study suggests that despite its balloon compliance, both safe overinflation and partial REBOA can be successfully achieved with the COBRA-OS.
Basic science.
有多种能够进行主动脉复苏性血管内球囊阻断术（REBOA）的装置，其中大多数含有顺应性球囊材料。虽然顺应性材料因其“缓冲”作用而非常适合球囊充气，但在放气过程中“控制”起来可能会有问题。COBRA-OS（出血控制、复苏、动脉闭塞系统）旨在优化其顺应性球囊的充气和放气，并就其过度充气和部分REBOA能力进行了体外和体内测试。
对于过度充气，将COBRA-OS在三种不同内径（ID）的乙烯管中充气直至球囊破裂。然后在六个采集的猪主动脉以及三只麻醉猪的所有三个REBOA区域中对其进行过度充气。对于部分REBOA，COBRA-OS在脉动台式主动脉模型以及三只麻醉猪的第1区中进行逐步放气。
对于过度充气，与已知的4个大气压的主动脉破裂阈值相比，COBRA-OS仅在最小的乙烯管中超过了该值：内径8毫米的管，6.5个大气压；内径9.5毫米的管，3.5个大气压；内径13毫米的管，1.5个大气压。它在体外还显示出超过500％的过度充气能力且无主动脉损伤，并且在体内充气至最大充气量时未造成主动脉损伤。对于部分REBOA，COBRA-OS在脉动血管模型（3.4±0.12毫升）和麻醉猪（3.8±0.35毫升）中均能够提供3毫升至4毫升的滴定窗口。
COBRA-OS在体外和体内均显示出在充气过程中具有缓冲作用并结合放气时的滴定控制能力。这项研究表明，尽管其球囊具有顺应性，但使用COBRA-OS仍可成功实现安全的过度充气和部分REBOA。
基础科学。
