Morgan R Barron, MD, John Kuckelman, DO, John McClellan, MD, Michael Derickson, MD, Cody Phillips, DO, Shannon Marko, DVM, Kyle Sokol, MD, Rowan Sheldon, MDMatthew Eckert, MD, Matthew Martin, MD. Madigan Army Medical Center
Introduction: Objective assessment of final REBOA position and adequate distal occlusion is clinically limited, particularly in patients with hemorrhagic shock. We propose that mobile forward looking infrared (FLIR) thermal imaging is a fast, reliable, and non-invasive method to assess REBOA position and efficacy in scenarios applicable to battlefield care.
Methods: Ten swine were randomized to a 40% hemorrhage group (H, n=5) or non-hemorrhage group (NH, n=5). Three experiments were completed after zone one placement of a REBOA catheter. REBOA was deployed for 30 minutes in all animals followed by randomized continued deployment vs sham in both light and blackout conditions. FLIR images and hemodynamic data were obtained. Images were presented to 62 blinded observers for assessment of REBOA inflation status.
Results: There was no difference in hemodynamic or laboratory values at baseline. The H group was significantly more hypotensive (MAP 44 vs 60, p<0.01), vasodilated (SVR 634 vs 938, p=0.02), and anemic (HCT 12 vs 23.2, p<0.01). H animals remained more hypotensive, anemic, and acidotic throughout all 3 experiments. There was a significant difference in the temperature change (ΔTemp) measured by FLIR between animals with REBOA inflated vs not inflated (5.7°C vs 0.7°C, p<0.01). There was no significant difference in FLIR ΔTemp between NH and H when balloon was inflated or deflated. Blinded observer analysis of FLIR images correctly identified adequate REBOA inflation and aortic occlusion 95.4% at 5 minutes and 98.8% at 10 minutes (PPV5min = 99% and PPV10min = 100%).
Discussion: Mobile thermal imaging is an easy, rapid, and reliable method for assessing distal perfusion after occlusion by REBOA. Smart phone based FLIR technology allows for confirmation of adequate REBOA placement at the point of care, and performance was not degraded in the setting of major hemorrhage or blackout conditions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86491
Program Number: MSS15
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium