Non-compressible torso hemorrhage control with intravascular ultrasound guided resuscitative endovascular balloon occlusion.

INTRODUCTION

We sought to determine the feasibility of REBOA placement under intravascular ultrasound (IVUS) guidance and to determine flow dynamics while undergoing aortic occlusion of non-compressible torso hemorrhage (NCTH) secondary to aortic branch vessel injury.

METHODS

Ten Sus scrofa swine underwent laparotomy to create an artificial arteriovenous shunt between a mesenteric vessel and the IVC to simulate ongoing hemorrhage with auto-resuscitation. An IVUS catheter was advanced to the level of injury. A full- or partial-REBOA was then deployed proximally under IVUS guidance. Continuous hemodynamic data were collected.

RESULTS

All devices were placed successfully using IVUS. Comparing full- and partial-REBOA, femoral pressures were decreased (34% vs. 95%), and carotid pressures were increased (276% vs. 144%). Shunt flow was 26% of baseline for full-REBOA and 75% for partial-REBOA.

CONCLUSION

Endovascular localization and treatment of hemorrhage has potential to advance combat casualty care through delivery of interventional approaches in a mobile technique with IVUS.