L. Carrillo1, M. Skibber1, A. Kumar1, C. Cox1 1McGovern Medical School at UTHealth,Department Of Pediatric Surgery,Houston, TX, USA
Introduction: The Resuscitative Endovascular Balloon Occlusion (REBOA) device has been adapted for Inferior Vena Cava (IVC) use as an adjunct to control massive hemorrhage in both animal models and human cases. While rare, IVC injuries in unstable pediatric patients have been associated with a 67% mortality rate.
Methods: A simulated venous system was designed with modeled IVC components and a 1L/min outflow. These IVC segments were derived from measurements of 300 pediatric trauma computer tomography (CT) scans and reflect post and prehepatic diameters for the five largest Broselow categories. A REBOA device was inserted into the system with the balloon placed in the IVC model. Pressure monitors were placed distally and on a tank replicating the capacitance of the venous system. A Flow meter was placed distally to the segment and balloon. Flow and pressure readings were recorded as the REBOA device was inflated at .2cc/second.
Results: With the low flow of the venous system approximately 80-90% of the inflation volume occurs with the first 10% of occlusion. This reduction in flow corresponded with an increased pressure difference, reflecting the increased volume in the venous system.
Conclusion: Pediatric IVC injuries with significant hemorrhage may be amenable to endovascular occlusion as an adjunct to resuscitation and operative management
