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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

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.

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Funding

This work was funded by the Telemedicine and Advanced Technology Research Center (TATRC) at the United States Army Medical Research and Materiel Command through the AMEDD Advanced Medical Technology Initiative (AAMTI).

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Authors and Affiliations

  1. Department of Surgery, Naval Medical Center San Diego, San Diego, CA, USA

    Derek A. Benham, Matthew J. Carr, Lyndsey Wessels, Joseph J. Lee, Andrew Schrader & Michael Krzyzaniak

  2. Trauma Service (MER62), Department of Surgery, Scripps Mercy Hospital, 4077 Fifth Avenue, San Diego, CA, 92103, USA

    Richard Y. Calvo & Matthew J. Martin

  3. Department of Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA, USA

    Torbjorg Holtestaul, Daniel Lammers, Ian Jones, Jeffrey Connor, Jessica Weiss & Matthew J. Eckert

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  1. Derek A. Benham
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  2. Matthew J. Carr
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Contributions

DB, LW, MC, MM, and MK contributed to the literature search; LW, DB, AS, MC, DL, ME, MK, and MM contributed to the study design; DB, MC, JL, RC, AS, TH, DL, IJ, JC, and JW collected the data; DB, TH, RC, MC, MK, ME, and MM interpreted the data; DB, LW, MC, MK, and MM wrote the article; DB, MC, LW, JL, RC, AS, TH, DL, IJ, JC, JW, ME, MK, and MM performed critical revisions.

Corresponding author

Correspondence to Matthew J. Martin.

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The authors have no conflicts of interest to report.

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Picture 1: COMPASS devices used during experimentation

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Benham, D.A., Carr, M.J., Wessels, L. et al. Validation of a miniaturized handheld arterial pressure monitor for guiding full and partial REBOA use during resuscitation. Eur J Trauma Emerg Surg 49, 795–801 (2023). https://doi.org/10.1007/s00068-022-02121-8

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