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Road to REBOA Complication Eradication: 4D-CT Perfusion Analysis

Research Project

Project/Area Number 19K18344
Research Category

Grant-in-Aid for Early-Career Scientists

Allocation TypeMulti-year Fund
Review Section Basic Section 55060:Emergency medicine-related
Research InstitutionChiba University

Principal Investigator

Matsumura Yosuke  千葉大学, 大学院医学研究院, 特任助教 (00466707)

Project Period (FY) 2019-04-01 – 2023-03-31
Project Status Completed (Fiscal Year 2022)
Budget Amount *help
¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000)
Fiscal Year 2020: ¥1,950,000 (Direct Cost: ¥1,500,000、Indirect Cost: ¥450,000)
Fiscal Year 2019: ¥2,340,000 (Direct Cost: ¥1,800,000、Indirect Cost: ¥540,000)
KeywordsREBOA / Partial REBOA / organ perfusion / 臓器灌流 / 出血性ショック / Occlusion tolerance
Outline of Research at the Start

Resuscitative endovascular balloon occlusion of the aorta (REBOA) は大動脈内をバルーン遮断することで中枢部分の昇圧により重症出血性ショックの蘇生に寄与しうる一方,遠位臓器の虚血性合併症を惹起しうる. 出血性ショックモデルにおいて,バルーン部分遮断 (P-REBOA)中の臓器灌流を造影CT perfusionにより評価し,遮断強度を定量評価する.さらに,遮断強度ごとの Occlusion tolerance (遮断強度ごとに許容される遮断可能時間) を明らかにすることで, 合併症の発生有無の評価ではなく, 合併症を回避しうる遮断方法を探索する.

Outline of Final Research Achievements

REBOA is an aortic occlusion technique using a balloon catheter in hemorrhagic shock patients. Organ perfusion of partial REBOA (P-REBOA) was evaluated using 4D-CT analysis. The percentage of balloon volume (BV) to the loss of femoral artery pulse pressure (BV) was used as an index of blockade intensity. In the non-bleeding state, 4D-CT was analyzed with a blocking intensity of 0-100%. The area under the curve (AUTDC) of TDC decreased linearly with blocking intensity. %BV could estimate organ perfusion in the non-bleeding state. In the hemorrhagic shock model, AUTDC decreased linearly with %BV. 4D volume rendering (VR), which visualized the hemodynamics of the aorta and inferior vena cava, showed marked venous congestion in non-bleeding conditions at high blocking intensities [80-100%]. In contrast, congestion was not observed in the hemorrhagic shock. % BV can estimate organ perfusion during P-REBOA in non-bleeding and hemorrhagic shock.

Academic Significance and Societal Importance of the Research Achievements

出血性ショックの蘇生に用いられるREBOAの合併症を根絶するためには,P-REBOA中の臓器灌流を推定することが必要であった.バルーン注入量でP-REBOAの遮断強度を定義した.P-REBOA臓器潅流とバルーン注入量の関連を検証した.非出血時・出血性ショックに拘わらず,バルーン注入量と臓器潅流が線形に変化することを明らかにした学術的意義が大きい.さらに,バルーン注入量という非侵襲的かつ簡便な指標で推定することは臨床応用がしやすく,出血性ショック患者救命への社会的意義が大きい.

Report

(5 results)
  • 2022 Annual Research Report   Final Research Report ( PDF )
  • 2021 Research-status Report
  • 2020 Research-status Report
  • 2019 Research-status Report
  • Research Products

    (7 results)

All 2022 2021 2020 2019

All Journal Article (3 results) (of which Peer Reviewed: 3 results,  Open Access: 1 results) Presentation (4 results) (of which Int'l Joint Research: 3 results)

  • [Journal Article] Organ perfusion during partial REBOA in haemorrhagic shock: dynamic 4D-CT analyses in swine2022

    • Author(s)
      Matsumura Y, Higashi A, Izawa Y, Hishikawa S.
    • Journal Title

      Sci Rep

      Volume: 12 Issue: 1 Pages: 18745-18745

    • DOI

      10.1038/s41598-022-23524-y

    • Related Report
      2022 Annual Research Report
    • Peer Reviewed / Open Access
  • [Journal Article] Organ ischemia during partial resuscitative endovascular balloon occlusion of the aorta: Dynamic 4D Computed tomography in swine2020

    • Author(s)
      Matsumura Y, Higashi A, Izawa Y, Hishikawa S, Kondo H, Reva V, Oda S, Matsumoto J.
    • Journal Title

      Sci Rep.

      Volume: 10 Issue: 1 Pages: 5680-5680

    • DOI

      10.1038/s41598-020-62582-y

    • Related Report
      2020 Research-status Report 2019 Research-status Report
    • Peer Reviewed
  • [Journal Article] Distal pressure monitoring and titration with percent balloon volume: feasible management of partial resuscitative endovascular balloon occlusion of the aorta (P-REBOA)2019

    • Author(s)
      Matsumura Y, Higashi A, Izawa Y, Hishikawa S, Kondo H, Reva V, Oda S, Matsumoto J.
    • Journal Title

      Eur J Trauma Emerg Surg

      Volume: 47 Issue: 4 Pages: 1023

    • DOI

      10.1007/s00068-019-01257-4

    • Related Report
      2019 Research-status Report
    • Peer Reviewed
  • [Presentation] Partial REBOAにおける臓器灌流と血流動態: ブタ出血性ショックモデルにおけるdynamic 4D-CT2021

    • Author(s)
      松村洋輔,林洋輔,東晶子,伊澤祥光
    • Organizer
      第48回日本集中治療医学会学術集会
    • Related Report
      2020 Research-status Report
  • [Presentation] Future aspects of REBOA What do we need to learn and know? Ongoing studies/Developments.2020

    • Author(s)
      Matsumura Y, Matsumoto J.
    • Organizer
      European Society of Vascular Surgery & Endovascular resuscitation and Trauma Management Society
    • Related Report
      2020 Research-status Report
    • Int'l Joint Research
  • [Presentation] 4D-CT Evaluation of Organ Ischemia: Is There a role for Partial REBOA to Extend Aortic Occlusion Time?2019

    • Author(s)
      Matsumura Y.
    • Organizer
      The 2nd Pan-American Endovascular Resuscitation & Trauma Management Symposium.
    • Related Report
      2019 Research-status Report
    • Int'l Joint Research
  • [Presentation] Evaluation of organ perfusion in partial REBOA analyzed by CT perfusion in swine.2019

    • Author(s)
      Matsumura Y, Higashi A, Hishikawa S, Izawa Y, H, Reva V, Oda S, Matsumoto J.
    • Organizer
      The 20th European Congress of Trauma & Emergency Surgery
    • Related Report
      2019 Research-status Report
    • Int'l Joint Research

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Published: 2019-04-18   Modified: 2024-01-30  

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