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Validation of a miniaturized handheld arterial pressure monitor for guiding full and partial REBOA use during resuscitation. Eur J Trauma Emerg Surg 2022; 49:795-801. [PMID: 36273349 DOI: 10.1007/s00068-022-02121-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
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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Torres‐Gonzalez BH, Powell TL, Yee J, Hunold KM. Novel technique for continuous pressure monitoring of esophageal balloon in balloon tamponade device for acute variceal bleed. J Am Coll Emerg Physicians Open 2022; 3:e12725. [PMID: 35505932 PMCID: PMC9051862 DOI: 10.1002/emp2.12725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Abstract
Acute variceal bleeding is a life‐threatening emergency associated with high mortality. Balloon tamponade is required for refractory bleeding to allow stabilization for definitive therapy. Unfortunately, these devices are associated with iatrogenic complications such as esophageal necrosis and perforation. It is imperative to accurately measure the esophageal balloon pressure to limit these complications. We describe a novel technique for both initial and continuous pressure monitoring of the esophageal balloon.
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Affiliation(s)
| | - Thomas L. Powell
- Department of Emergency Medicine The Ohio State University Ohio Columbus USA
| | - Jennifer Yee
- Department of Emergency Medicine The Ohio State University Ohio Columbus USA
| | - Katherine M. Hunold
- Department of Emergency Medicine The Ohio State University Ohio Columbus USA
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Carr MJ, Benham DA, Lee JJ, Calvo RY, Wessels LE, Schrader AJ, Krzyzaniak MJ, Martin MJ. Real-time bedside management and titration of partial resuscitative endovascular balloon occlusion of the aorta without an arterial line: Good for pressure, not for flow! J Trauma Acute Care Surg 2021; 90:615-622. [PMID: 33405469 DOI: 10.1097/ta.0000000000003059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) attempts to minimize ischemia/reperfusion injury while controlling hemorrhage. There are little data on optimal methods to evaluate and titrate partial flow, which typically requires invasive arterial line monitoring. We sought to examine the use of a miniaturized handheld digital pressure device (COMPASS; Mirador Biomedical, Seattle, WA) for pREBOA placement and titration of flow. METHODS Ten swine underwent standardized hemorrhagic shock. Carotid and iliac pressures were monitored with both arterial line and COMPASS devices, and flow was monitored by aortic and superior mesenteric artery flow probes. Partial resuscitative endovascular balloon occlusion of the aorta was inflated to control hemorrhage for 15 minutes before being deflated to try targeting aortic flow of 0.7 L/min (using only the COMPASS device) by an operator blinded to the arterial line pressures and aortic flow. Correlations between COMPASS and proximal/distal arterial line were evaluated, as well as actual aortic flow. RESULTS There was strong correlation between the distal mean arterial pressure (MAP) and the distal COMPASS MAP (r = 0.979, p < 0.01), as well as between the proximal arterial line and the proximal COMPASS on the pREBOA (r = 0.989, p < 0.01). There was a significant but weaker correlation between the distal compass MAP reading and aortic flow (r = 0.47, p < 0.0001), although it was not clinically significant and predicted flow was not achieved in a majority of the procedures. Of 10 pigs, survival times ranged from 10 to 120 minutes, with a mean survival of 50 minutes, and 1 pig surviving to 120 minutes. CONCLUSION Highly reliable pressure monitoring is achieved proximally and distally without arterial lines using the COMPASS device on the pREBOA. Despite accurate readings, distal MAPs were a poor indicator of aortic flow, and titration based upon distal MAPs did not provide reliable results. Further investigation will be required to find a suitable proxy for targeting specific aortic flow levels using pREBOA.
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Affiliation(s)
- Matthew J Carr
- From the Department of Surgery, Naval Medical Center San Diego (M.J.C., D.A.B., J.J.L., L.E.W., A.J.S., M.J.K.); and Trauma Service (R.Y.C., M.J.M.), Scripps Mercy Hospital, San Diego, California
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Sekhri NK, Parikh S, Weber GM. Comparison Of Digital Manometer And Water Column Manometer Pressures Measurements During Lumbar Puncture. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:451-458. [PMID: 31754314 PMCID: PMC6825514 DOI: 10.2147/mder.s225757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) pressure measurement is routinely performed via a conventional water column manometer. There is increasing interest in using a digital manometer in measuring CSF pressures. The aim of this study is to compare column and digital manometers, in addition to measuring time to acquire the pressure readings. Research design and methods This prospective study included 27 patients who were referred for a fluoroscopically guided lumbar puncture. Opening pressure and closing pressure measurements were done with a digital manometer and then a traditional water column manometer. The time to obtain each pressure measurement was also recorded and compared. Results Mean time to obtain pressure reading was significantly lower in the digital manometer group when compared to the water column manometer group (8.1 seconds vs. 42.2 seconds, P<0.05 for opening pressure and 8.92 seconds vs. 45.15 seconds, P<0.05 for closing pressure). Correlation between the opening pressure measurements (Pearson coefficient r= 0.98) and closing pressure (Pearson coefficient r= 0.89) was strong. However, the digital manometer reading consistently read higher. Conclusion Digital manometry during an LP yielded is faster however there might be a clinical difference between the devices. Clinicians must be careful in using the device across all cases.
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Affiliation(s)
- Nitin K Sekhri
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,Department of Anesthesiology, New York Medical College, Valhalla, New York, USA
| | - Shalvi Parikh
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Garret M Weber
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA.,Department of Anesthesiology, New York Medical College, Valhalla, New York, USA
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Palermo C, Sanfiorenzo A, Giaquinta AT, Virgilo C, Veroux M, Veroux P. Mini-invasive treatment of a large pseudoaneurysm of the neck related to central venous catheter placement: A case report. Medicine (Baltimore) 2018; 97:e11262. [PMID: 30024504 PMCID: PMC6086494 DOI: 10.1097/md.0000000000011262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Central venous catheter (CVC) placement, particularly in emergency setting, may be associated with significant morbidity and mortality. PATIENT CONCERNS A 33-year old woman with suspected pulmonary embolism, developed a pseudoaneurysm of the neck three days after a CVC placement in the right internal jugular vein, determining compression to adjacent neck structures. DIAGNOSES Computed tomography angiography and selective angiography demonstrated the presence of the pseudoaneurysm originating from the thyro-cervical trunk. INTERVENTIONS The treatment was minimally invasive with endovascular exclusion first, and an open thrombectomy to resolve compressive syndrome two days later. OUTCOMES The color Doppler ultrasound confirmed the complete exclusion of the pseudoaneurysm with patency of the thyroid artery. A comprehensive review of literature on the risk factors and management of the unintended artery puncture was included. LESSONS A correct technique under ultrasound guidance may reduce the incidence of unintended arterial injury during CVC placement. In patients with suitable anatomy and unfit for open repair, a minimally invasive approach provides a safe alternative to open surgery with excellent results.
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Ikhsan M, Tan KK, Putra AS. Assistive technology for ultrasound-guided central venous catheter placement. J Med Ultrason (2001) 2017; 45:41-57. [DOI: 10.1007/s10396-017-0789-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 03/30/2017] [Indexed: 11/28/2022]
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Balthasar AJR, van Geffen GJ, van der Voort M, Lucassen GW, Roggeveen S, Bruaset IJ, Bruhn J. Spectral tissue sensing to identify intra- and extravascular needle placement - A randomized single-blind controlled trial. PLoS One 2017; 12:e0172662. [PMID: 28278194 PMCID: PMC5344374 DOI: 10.1371/journal.pone.0172662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 02/08/2017] [Indexed: 11/18/2022] Open
Abstract
Safe vascular access is a prerequisite for intravenous drug admission. Discrimination between intra- and extravascular needle position is essential for procedure safety. Spectral tissue sensing (STS), based on optical spectroscopy, can provide tissue information directly from the needle tip. The primary objective of the trial was to investigate if STS can reliably discriminate intra-vascular (venous) from non-vascular punctures. In 20 healthy volunteers, a needle with an STS stylet was inserted, and measurements were performed for two intended locations: the first was subcutaneous, while the second location was randomly selected as either subcutaneous or intravenous. The needle position was assessed using ultrasound (US) and aspiration. The operators who collected the data from the spectral device were blinded to the insertion and ultrasonographic visualization procedure and the physician was blinded to the spectral data. Following offline spectral analysis, a prediction of intravascular or subcutaneous needle placement was made and compared with the “true” needle tip position as indicated by US and aspiration. Data for 19 volunteers were included in the analysis. Six out of 8 intended vascular needle placements were defined as intravascular according to US and aspiration. The remaining two intended vascular needle placements were negative for aspiration. For the other 11 final needle locations, the needle was clearly subcutaneous according to US examination and no blood was aspirated. The Mann-Whitney U test yielded a p-value of 0.012 for the between-group comparison. The differences between extra- and intravascular were in the within-group comparison computed with the Wilcoxon signed-rank test was a p-value of 0.022. In conclusion, STS is a promising method for discriminating between intravascular and extravascular needle placement. The information provided by this method may complement current methods for detecting an intravascular needle position.
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Affiliation(s)
- Andrea J. R. Balthasar
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- * E-mail:
| | - Geert-Jan van Geffen
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Ivar J. Bruaset
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Joergen Bruhn
- Department of Anesthesiology, Radboud University Medical Center, Nijmegen, The Netherlands
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Ultrasound Identification of the Guidewire in the Brachiocephalic Vein for the Prevention of Inadvertent Arterial Catheterization During Internal Jugular Central Venous Catheter Placement. Anesth Analg 2016; 123:896-900. [DOI: 10.1213/ane.0000000000001446] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ruan J, Zhang C, Peng Z, Tang DY, Feng Z. Inferior thyroid artery pseudoaneurysm associated with internal jugular vein puncture: a case report. BMC Anesthesiol 2015; 15:71. [PMID: 25943354 PMCID: PMC4432982 DOI: 10.1186/s12871-015-0052-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 04/23/2015] [Indexed: 11/16/2022] Open
Abstract
Background Central venous catheter placement is an important aspect of patient care for the administration of fluids and medications and for monitoring purposes. However, it is still associated with significant morbidity and mortality. Case presentation We report a case of iatrogenic inferior thyroid artery pseudoaneurysm during the central line placement due to internal jugular vein puncture. This is a rare complication of central venous cannulation. Fortunately the pseudoaneurysm was monitored closely, diagnosed promptly and obliterated by using radiological intervention. We discuss the risk factors and management of the unintended artery puncture. Conclusion The pathway of the management post arterial puncture depends on the size of the needle or catheter, which is direct related to the consequence of arterial injuries. Identifying risk factors is very important to avoid the complications. However, the use of ultrasound guided venipuncture is the most important method to avoid mechanical complications.
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Affiliation(s)
- Jinguang Ruan
- Department of Anesthesiology and Pain Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Cao Zhang
- Department of Anesthesiology, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China.
| | - Zhiyou Peng
- Department of Anesthesiology and Pain Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - David Yue Tang
- Department of Anesthesiology, Mercy General Hospital, Sacramento, CA, USA.
| | - Zhiying Feng
- Department of Anesthesiology and Pain Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Park JS, Lee BK, Jeung KW, Choi SS, Park SW, Song KH, Lee SM, Heo T, Min YI. Reliability of blood color and blood gases in discriminating arterial from venous puncture during cardiopulmonary resuscitation. Am J Emerg Med 2015; 33:553-8. [DOI: 10.1016/j.ajem.2015.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 11/30/2022] Open
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Yen CC, Chiu YW, Chen HC. Remove or not, that is the question: A case report on carotid artery cannulation during indwelling venous hemodialysis catheter. Hemodial Int 2015; 19:E17-20. [DOI: 10.1111/hdi.12297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Cheng-Chieh Yen
- Division of Nephrology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
| | - Hung-Chun Chen
- Division of Nephrology; Department of Internal Medicine; Kaohsiung Medical University Hospital; Kaohsiung Medical University; Kaohsiung Taiwan
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Durajska K, Januszkiewicz E, Szmygel Ł, Kosiak W. Inferior vena cava/aorta diameter index in the assessment of the body fluid status - a comparative study of measurements performed by experienced and inexperienced examiners in a group of young adults. J Ultrason 2014; 14:273-9. [PMID: 26675322 PMCID: PMC4579687 DOI: 10.15557/jou.2014.0027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 11/08/2013] [Accepted: 11/13/2013] [Indexed: 12/21/2022] Open
Abstract
The assessment of the body fluid status is one the most challenging tasks in clinical practice. Although there are many methods to assess the body fluid status of patients, none of them is fully satisfactory in contemporary medical sciences. In the article below, we compare the results of measurements performed by experienced and inexperienced examiners based on the inferior vena cava/aorta diameter index in a sonographic hydration assessment. The study enrolled 50 young students at the age of 19-26 (the median age was 22.95) including 27 women and 23 men. The volunteers were examined in the supine position with GE Logiq 7 system and a convex transducer with the frequency of 2-5 MHz. The measurements were performed in the longitudinal and transverse planes by two inexperienced examiners - the authors of this paper, following a four-hour training conducted by an experienced sonographer. The longitudinal values of the inferior vena cava/aorta diameter index obtained in this study were similar to those found in the literature. The reference value for the inferior vena cava/aorta index determined by Kosiak et al., which constituted 1.2 ± 2 SD, for SD = 0.17, was similar to the values obtained by the authors of this paper which equaled 1.2286 ± 2 SD, for SD = 0.2. The article presented below proves that measuring the inferior vena cava/aorta diameter index is not a complex examination and it may be performed by physicians with no sonographic experience. Furthermore, the paper demonstrates that the inferior vena cava/aorta diameter index measured in the transverse plane is similar to the inferior vena cava/aorta diameter index determined in the longitudinal plane. Thus, both measurements may be used interchangeably to assess the hydration status of patients.
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Affiliation(s)
- Kaja Durajska
- Ultrasound Student Association at the Laboratory of Diagnostic Ultrasound and Biopsy, Department of Pediatrics, Oncology, Hematology and Endocrinology, University Clinical Center in Gdańsk, Gdańsk, Poland
| | - Emilia Januszkiewicz
- Ultrasound Student Association at the Laboratory of Diagnostic Ultrasound and Biopsy, Department of Pediatrics, Oncology, Hematology and Endocrinology, University Clinical Center in Gdańsk, Gdańsk, Poland
| | - Łukasz Szmygel
- Department of Pediatrics, Diabetology and Endocrinology, University Clinical Center in Gdańsk, Gdańsk, Poland
| | - Wojciech Kosiak
- Laboratory of Diagnostic Ultrasound and Biopsy, Department of Pediatrics, Oncology, Hematology and Endocrinology, University Clinical Center in Gdańsk, Gdańsk, Poland
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Bowdle A. Vascular Complications of Central Venous Catheter Placement: Evidence-Based Methods for Prevention and Treatment. J Cardiothorac Vasc Anesth 2014; 28:358-68. [DOI: 10.1053/j.jvca.2013.02.027] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Indexed: 01/04/2023]
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