For Trauma, Aortic Balloon Tx May Not Require Imaging

An endovascular procedure for treating noncompressible truncal hemorrhages may be feasible in trauma bays and other prehospital settings that lack fluoroscopy, researchers found.

Resuscitative endovascular balloon occlusion of the aorta, as a less invasive alternative to resuscitative thoracotomy, could be performed with blind placement in approximately 94% of the general population, according to Eric J. Voiglio, MD, PhD, of Centre Hospitalier Lyon-Sud, France, and colleagues.

In a study published online in JAMA Surgery, they described a fixed-distance model in which specific portions within the aorta could be eyeballed to treat these kinds of hemorrhage that are common in both civilian and military trauma settings.

Starting from either femoral artery at the upper border of the symphysis pubis -- an easily identifiable external landmark -- Voiglio's group found that a segment extending 414 to 474 mm toward the descending thoracic aorta existed in all patients in their study. Also very common were the segments between the right and left femoral arteries to the infrarenal aorta; segments measured 236 to 256 mm and were present in 99.6% and 97.9% of patients, respectively.

These descending thoracic aorta and infrarenal aorta segments are expected to exist in 98.7% and 94.9% of the general population, the authors predicted.

"The aim of this study was to develop a fixed-distance model by determining whether there are specific portions within ... the aorta that are at a reliable and reproducible distance from a standardized point of entry and that could be used as targets for the positioning of the balloon during resuscitative endovascular balloon occlusion of the aorta in a civilian population."

"These findings support the expanded use of resuscitative endovascular balloon occlusion of the aorta in emergency department and prehospital settings," Voiglio and colleagues concluded.

Their retrospective study included whole-body CT scans of 280 consecutive civilian trauma patients at France's University Hospitals of Lyon (50% men, average age 38.8 years).

"Although [the investigators] have included a more heterogeneous population than similar previous studies of male combatants, their study population may be younger and thinner than the general population or the trauma populations seen in [U.S.] trauma centers," Michael D. Goodman, MD, and Timothy A. Pritts, MD, PhD, both of University of Cincinnati, pointed out in an accompanying editorial. "In addition, further adjustments may be required based on catheter selection, vascular calcification encountered, or access to the femoral artery via the cutdown technique."

"Nevertheless, [Voiglio and co-authors] have provided a starting point for standardized fixed-distance definitions for [resuscitative endovascular balloon] placement in the setting of limited immediate imaging access."