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

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K18344
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 55060:Emergency medicine-related
• Research Institution: Chiba 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
• Keywords: REBOA / Partial REBOA / organ perfusion / 臓器灌流 / 出血性ショック

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.

Free Research Field

救急集中治療医学

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．