Balloons for kids: Anatomic candidacy and optimal catheter size for pediatric resuscitative endovascular balloon occlusion of the aorta. Issue 4 (6th April 2022)

• Record Type: Journal Article
• Authors: Sykes, Alicia Gaidry; Sisson, William B.; Wang, Lucas J.; Martin, Matthew J.; Thangarajah, Hariharan; Naheedy, John; Fernandez, Nathanial; Nelles, Meghan E.; Ignacio, Romeo C.
• Is Part Of: Journal of trauma and acute care surgery. Volume 92:Issue 4(2022)
• Page Start: 743
• Page End: 747
• Publication Date: 2022-04-06
• Subjects: Resuscitative endovascular balloon occlusion of the aorta -- REBOA -- pediatric -- pediatric trauma; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000003521
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : This study evaluates the vascular dimensions and anatomic limitations of utilizing REBOA in children and provides recommended REBOA catheter sizes for children by Broselow category. Abstract : BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potential adjunct in pediatric trauma patients with noncompressible truncal and pelvic hemorrhage; however, there are little data evaluating the anatomic considerations of REBOA in children. We evaluated the vascular dimensions and anatomic limitations of using REBOA in children. METHODS: Computed tomography scans of pediatric patients performed between February 2016 and October 2019 were retrospectively reviewed by two investigators. Vascular measurements included diameters of aorta zones I and III, common iliac arteries, external iliac arteries, and common femoral arteries (CFAs), and distances between access site (CFA) and aorta zones I and III. Measurements were grouped within Broselow categories, based upon patient height. Interrater reliability for measurements was determined using intraclass correlation coefficients. Vascular dimensions were correlated with the patient's height, weight, and body mass index using linear regression analysis. RESULTS: A total of 557 computed tomography scans met the inclusion criteria and were reviewed. Measurements of vessel diameter and distance from the CFA to aorta zones I and III were determined and grouped by Broselow category. Patient age ranged from 0 to 18 years, with a male to female ratio of 1:1. Overall interrater reliability of vessel measurements was good (average intraclass correlation coefficient, 0.90). Vessel diameter had greatest correlation with height ( R 2 = 0.665, aorta zone I; R 2 = 0.611, aorta zone III) and poorly correlated with body mass index ( R 2 = 0.318 and R 2 = 0.290, respectively). CONCLUSION: This study represents the largest compilation of REBOA-related pediatric vessel diameter measurements and the first to provide data on distance between access site and balloon deployment zones. Based on our findings, the 7-Fr REBOA catheter would be appropriate for the Black, Green, and Orange Broselow categories, and a 4-Fr REBOA catheter would be warranted for Yellow, White, and Blue Broselow categories. LEVEL OF EVIDENCE: Prognostic and epidemiological, level III. Abstract :