Configuration of the partial REBOA intensity and validation of the occlusion tolerance using CT perfusion analysis

2018 Fiscal Year Final Research Report

• Project/Area Number: 17H06567
• Research Category: Grant-in-Aid for Research Activity Start-up
• Allocation Type: Single-year Grants
• Research Field: Emergency medicine
• Research Institution: Chiba University
• Principal Investigator: Matsumura Yosuke 千葉大学, 医学部附属病院, 助教 (00466707)
• Research Collaborator: HIGASHI akiko ; HISHIKAWA syuji ; IZAWA yoshimitsu ; KONDO hiroshi ; ODA shigeto ; REVA victor
• Project Period (FY): 2017-08-25 – 2019-03-31
• Keywords: REBOA / partial REBOA / P-REBOA / organ perfusion / CT-perfusion

Outline of Final Research Achievements

[Background] REBOA increases proximal pressure, and simultaneously induces distal ischemia. The association between the degree of P-REBOA and organ ischemia has not been evaluated. [Methods] Total REBOA was defined as the cessation of distal pulse pressure, and the maximum volume was recorded. The animals were scanned at each 20% inflation of the maximum volume, and CT perfusion data were analyzed at PV, liver parenchyma, and SMV (indicating mesenteric perfusion). AUC of the TDC were calculated. [Results] The TDC of the PV, liver, and SMV showed a decreased peak and delayed TTP, and the AUC of the TDC decreased linearly consistently with balloon inflation (PV, Y=-1.071*X+106.8, r2=0.972, P=0.0003; liver, Y=-1.050*X+101.8, r2=0.933, P=0.0017; SMV, Y=-0.985*X+100.3, r2=0.952, P=0.0009). [Conclusion] CT perfusion analysis may indicate blood flow and organ ischemia during P-REBOA. The AUC of the TDCs at PV, liver, and SMV changed linearly according to balloon inflation.

Free Research Field

救急集中治療医学

Academic Significance and Societal Importance of the Research Achievements

REBOA (Resuscitative endovascular balloon occlusion of the aorta)は近位の昇圧により出血性ショックの有用な蘇生手段となるが，遠位臓器虚血が問題となる．バルーン部分遮断(P-REBOA)が臓器虚血軽減に寄与すると考えられ，造影CT perfusionにより臓器灌流を解析した．バルーン容量と肝臓や腸管臓器灌流が線形に変化する．完全遮断時のバルーン容量を基準とし，注入容量に着目して調整を行うことがREBOAの遮断強度調節に有用な可能性がある．