Department of Surgery, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, 2353 GA, The Netherlands.
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
World J Emerg Surg. 2024 Aug 31;19(1):29. doi: 10.1186/s13017-024-00557-4.
BACKGROUND (RATIONALE/PURPOSE/OBJECTIVE): Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporary control non-compressible truncal hemorrhage (NCTH) as bridge to definitive surgical treatment. The dependence on radiography for safe balloon positioning is one factor that limits the extended use of REBOA in civilian and military pre-hospital settings. We aimed to determine standardized sex and age-based variable-distance catheter insertion lengths for accurate REBOA placement without initial fluoroscopic confirmation.
Contrast enhanced CT-scans from a representative sample of a Dutch non-trauma population were retrospectively analyzed. Intravascular distances were measured from the bilateral common femoral artery access points (FAAP) to the middle of the aortic occlusion zones and accompanying boundaries. Means and 95% confidence intervals for the distances from the FAAPs to the boundaries and mid-zone III were calculated for all (combined) sex and age-based subgroups. Optimal insertion lengths and potentially safe regions were determined for these groups. Bootstrap analysis was performed in combination with a 40-mm long balloon introduction simulation to determine error-rates and REBOA placement accuracy for the general population.
In total, 1354 non-trauma patients (694 females) were included. Vascular distances increased with age and were longer in males. The iliofemoral trajectory was 7 mm longer on the right side. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion lengths showed up to 30 mm difference, ranging between 234 and 264 mm. Statistically significant and potentially clinically relevant differences were observed between the anatomical distances and necessary introduction depths for each subgroup.
This is the first study to compare aortic morphology and intravascular distances between combined sex and age-based subgroups. As zone III length was consistent, length variability and elongation seem to mainly originate in the iliofemoral trajectory and zone II. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion ranged between 234 and 264 mm. These standardized variable-distance insertion lengths could facilitate safer fluoroscopy-free REBOA in austere, pre-hospital settings.
背景（原理/目的/目标）：主动脉球囊阻断复苏术（REBOA）用于临时控制非压迫性躯干出血（NCTH），作为确定性手术治疗的桥梁。安全放置球囊对放射摄影的依赖性是限制 REBOA 在民用和军事现场前治疗中广泛应用的一个因素。我们旨在确定标准化的性别和年龄相关可变距离导管插入长度，以便在没有初始透视确认的情况下准确放置 REBOA。
回顾性分析了来自荷兰非创伤人群的代表性样本的对比增强 CT 扫描。从双侧股动脉入路点（FAAP）测量血管内距离到主动脉闭塞区域和伴随边界的中点。计算所有（合并）性别和年龄亚组中 FAAP 到边界和中区 III 的距离的平均值和 95%置信区间。为这些组确定了最佳插入长度和潜在安全区域。结合 40mm 长的球囊导入模拟进行了自举分析，以确定一般人群的错误率和 REBOA 放置准确性。
共纳入 1354 例非创伤患者（694 例女性）。血管距离随年龄增长而增加，男性更长。右侧的髂股轨迹长 7mm。最佳区 I 导管插入长度应为 430mm。最佳区 III 导管插入长度差异可达 30mm，范围在 234 至 264mm 之间。在每个亚组中，观察到解剖距离和必要的引入深度之间存在统计学显著和潜在临床相关的差异。
这是第一项比较基于性别和年龄的亚组主动脉形态和血管内距离的研究。由于区 III 长度一致，长度变化和伸长似乎主要源于髂股轨迹和区 II。最佳区 I 导管插入长度应为 430mm。最佳区 III 导管插入范围在 234 至 264mm 之间。这些标准化的可变距离插入长度可以在简陋的现场前治疗中促进更安全的无透视 REBOA。
