Validation of a miniaturized handheld arterial pressure monitor for guiding full and partial REBOA use during resuscitation.

Autor: Benham DA; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Carr MJ; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Wessels L; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Lee JJ; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Calvo RY; Trauma Service (MER62), Department of Surgery, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA., Schrader A; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Holtestaul T; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Lammers D; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Jones I; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Connor J; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Weiss J; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Eckert MJ; Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA., Krzyzaniak M; Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA., Martin MJ; Trauma Service (MER62), Department of Surgery, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA. martin.matthew@scrippshealth.org.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2023 Apr; Vol. 49 (2), pp. 795-801. Date of Electronic Publication: 2022 Oct 23.
DOI: 10.1007/s00068-022-02121-8
Abstrakt: Purpose: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a well-validated method for the control of noncompressible truncal hemorrhage. In lower resource or battlefield settings, the need for arterial line setup and monitoring is problematic and potentially prohibitive. We sought to evaluate the accuracy and precision of a miniaturized portable device (Centurion COMPASS ® ) versus standard arterial pressure monitoring using standard ER-REBOA and partial REBOA (pREBOA) as a high-fidelity and space-/time-conserving alternative.
Methods: A total of 40 swine underwent a four-phase validation/precision study (each phase using five ER-REBOAs and five pREBOAs). Phases I/II evaluated accuracy with full and pREBOA in uninjured animals. Phases III/IV duplicated the previous phases but in a severe hemorrhagic shock model. Carotid and femoral pressures were monitored with both intra-arterial pressure systems and the COMPASS ® device. The vascular flow was measured by aortic flow probes. Correlation and Bland-Altman analysis were performed.
Results: There was a strong correlation in accuracy testing of proximal and distal COMPASS ® devices compared to standard intra-arterial pressure monitoring (r = 0.94, 0.8; p < 0.005) as well as during precision testing (r = 0.98, 0.89 p < 0.005) in the uninjured phases. Similar accuracy and reliability were demonstrated in hemorrhagic shock, with a strong correlation for the proximal and distal COMPASS ® devices (r = 0.98, 0.97; p < 0.005), as well as during precision testing (r = 0.99, 0.95; p < 0.005) in both full and pREBOA scenarios. Bland-Altman analysis showed extremely low bias between the COMPASS ® and arterial line for both proximal (bias = 1.9) and distal (bias = 0.8) pressure measurements.
Conclusion: The COMPASS ® provides accurate and precise pressure measurements during standard and partial REBOA in both uninjured and shock conditions. This device may help extend and enhance capability in any low-resource/battlefield settings, or even eliminate the need for standard intra-arterial invasive pressure monitoring and external setup.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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