P-REBOA: Pediatric Resuscitative Endovascular Balloon Occlusion of the Aorta, A Model for Potential Pediatric Trauma Use
Louis Carrillo, MD, MPh; Max Skibber, BS; Akshita Kumar, MD. MS; Mitchell George, MD; Charles Cox, MD
University of Texas Health Science Center Houston Dept of Pediatric Surgery, Houston, TX
Background- The Resuscitative Endovascular Balloon Occlusion (REBOA) device is becoming more widespread in adult trauma but is not FDA approved for pediatric patients. Reports of their use in pediatric patients have been published but no guidelines currently exist. 3D printed aortic models present a method to test occlusion in different sized vessels spanning the sizes of pediatric patients.
Methods- A circulatory system was constructed using 3D printed aortas made of TangoPlus FullCure 930¨R). The diameters of the aorta at the xyphoid process and umbilicus for the 5 largest broselow size categories were used to create the vessels. The system included thoracic and cerebral vascular pathways with sonographic flow meters placed distal to the aorta sample as well as on the cerebral pathway. Pressure monitors were placed at the pump exit and in the cerebral and thoracic pathways. Flow and pressure readings were recorded as a REBOA device was inflated at .2cc/sec in the aorta.
Results- Distal flow and pressure decreased while cerebral perfusion increased with REBOA deployment. The distal flow measurements and REBOA volumes to occlude 50% and 25% of flow are seen in the attached graph.
Conclusions- Pediatric patients present with a wide range of vessel sizes that occlude with different REBOA infusions. This study provides a basis to establish initial infusion volumes for REBOA deployment in select pediatric patients.
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