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Open Access

Resuscitative endovascular balloon occlusion of the aorta: rupture risk and implications for blind inflation

Philip J Wasicek, William A Teeter, Megan L Brenner, Melanie R Hoehn, Thomas M Scalea, Jonathan J Morrison
DOI: 10.1136/tsaco-2017-000141 Published 24 January 2018
Philip J Wasicek
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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William A Teeter
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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Megan L Brenner
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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Melanie R Hoehn
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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Thomas M Scalea
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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Jonathan J Morrison
Program in Trauma/Critical Care, R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland, USA
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    Figure 1

    (A) Line drawing of an ER-REBOA catheter. Length ‘a’ is the intended working length, between radio-opaque markers, which is normally up to 37 mm. Length ‘b’ is the entire length of the balloon, including the ‘shoulders’, which are not intended to be in apposition with the vessel wall. Length ‘c’ is the diameter of the balloon. (B) Zone 3 resuscitative endovascular balloon occlusion of the aorta (REBOA) demonstrating appropriate balloon inflation. Note: rounded shoulders and a footprint of 31.4 mm, well within the intended working length of 37 mm. (C) Zone 3 REBOA demonstrating overinflation and elongation, with a balloon footprint of 51.1 mm. Same scale as (B).

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    Figure 2

    Two images demonstrating the propensity for the aorta to rupture in the longitudinal direction.

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    Figure 3

    Maximal circumferential stretch ratios compared with baseline aortic diameter. Linear regression, R2=0.72; P<0.001.

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    Figure 4

    (A) Circumferential compliance ratio compared to aortic diameter at maximum balloon inflation (24 mL, expected balloon diameter is 32 mm). R2=0.85. (B) Longitudinal compliance ratio compared with aortic diameter when balloon is inflated with 8 mL (expected balloon diameter is 20 mm). R2=0.85.

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Resuscitative endovascular balloon occlusion of the aorta: rupture risk and implications for blind inflation
Philip J Wasicek, William A Teeter, Megan L Brenner, Melanie R Hoehn, Thomas M Scalea, Jonathan J Morrison
Trauma Surg Acute Care Open Jan 2018, 3 (1) e000141; DOI: 10.1136/tsaco-2017-000141

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Resuscitative endovascular balloon occlusion of the aorta: rupture risk and implications for blind inflation
Philip J Wasicek, William A Teeter, Megan L Brenner, Melanie R Hoehn, Thomas M Scalea, Jonathan J Morrison
Trauma Surg Acute Care Open Jan 2018, 3 (1) e000141; DOI: 10.1136/tsaco-2017-000141
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Resuscitative endovascular balloon occlusion of the aorta: rupture risk and implications for blind inflation
Philip J Wasicek, William A Teeter, Megan L Brenner, Melanie R Hoehn, Thomas M Scalea, Jonathan J Morrison
Trauma Surgery & Acute Care Open Jan 2018, 3 (1) e000141; DOI: 10.1136/tsaco-2017-000141
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