Compact Arterial Monitoring Device Use in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): A Simple Validation Study in Swine

Introduction Hemorrhage is the leading cause of preventable death in trauma in both the military and civilian settings worldwide. Medical studies from Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) informed change in military prehospital medicine by influencing widespread tourniquet distribution and training on their use to stop life-threatening extremity hemorrhage. In the military setting, there has been a significant reduction in preventable death due to extremity exsanguination since the widespread implementation of tourniquets within the Department of Defense. However, noncompressible hemorrhage remains a significant cause of mortality, especially in the prehospital setting. In select patients, resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct that can be utilized to slow or stop non-compressible hemorrhage until the patient reaches definitive care. However, frontline medical providers face the challenge of reliable, accurate blood pressure measurement in REBOA patients. REBOA, used in conjunction with a small disposable pressure monitor, can bridge the gap in capabilities, creating a more balanced resuscitation and reducing blood product requirements with the added benefit of invasive blood pressure monitoring capability. The authors of this study propose the sustained use and further validation of a small, disposable pressure monitor in REBOA to monitor beat-to-beat variation in both hemodynamically stable and unstable patients and seek to offer a pathway for use in austere environments. Materials and methods Yorkshire swine (n = 4) were selected for partial REBOA (pREBOA) placement and compass transducer measurement in conjunction with a vascular experimental protocol. Appropriate vascular and arterial line access was obtained, hemorrhagic shock was initiated, and REBOA with an in-line Compass™ device (CD) pressure transducer (Centurion Medical Products, Williamston, MI) was used to occlude the aorta. Mean arterial pressures were measured via the CD, recorded, and compared to the control arterial line at hypotensive, normotensive, and hypertensive pressures. Results At hypotensive pressures, 30% of the CD readings fell within 1 mmHg of control arterial line readings, and 52.3% were within 2 mmHg. At normotensive pressures, 46% of the CD readings fell within 1 mmHg of control arterial line readings, and 64.2% were within 2 mmHg. At hypertensive pressures, 60% of the CD readings fell within 1 mmHg of control arterial line readings, and 82% were within 2 mmHg. All CD data points at all pressures were within 8 mmHg of the control arterial line readings. Conclusions In conclusion, the CD is a compact, inexpensive, portable pressure-sensing device that may potentially augment the safety and functionality of the REBOA in trauma patients both at the point of injury and in the hospital. This novel study conducted on four swine subjects demonstrated a remarkable correlation to the traditional equipment intensive arterial line setups, and issues of stasis and non-pulsatility were easily troubleshot. Future studies should investigate CD use in REBOA catheters under different physiological conditions, specifically arrhythmias, and in different environments (prehospital, air medical transport, and austere locations).