Approximation of Pediatric Morphometry for Resuscitative Endovascular Balloon Occlusion of the Aorta

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be beneficial in the management of traumatic and iatrogenic vascular and solid organ injuries in children, but requires an understanding of vessel diameter at the access site and landing zones. We adapted the Broselow Tape method to estimate aortic and femoral artery diameters for this purpose.
Methods: Computed tomography scans from trauma and non-trauma pediatric patients at a level 1 trauma center were reviewed for vascular dimensions at aorta Zone I, Zone III, and the common femoral artery (CFA). Vessel size was measured by two providers using a vascular software suite with a 10% interobserver comparison. Height was used to create linear regression equations for each location and calculate ranges for each Broselow Tape category.
Results: We reviewed scans from 110 patients ages 2–14 years with less than 8% interobserver variability. Of these, 64% were male and 46% were trauma patients. Height-based regression equations were closely correlated with vessel diameter: Zone I (mm) = [0.093 ± 0.006 ⋅ height (cm)] + 0.589 ± 0.768; R² = 0.714, p < 0.001; Zone III (mm) = [0.083 ± 0.005 ⋅ height (cm)] – 0.703 ± 0.660; and R² = 0.728, p < 0.001; CFA (mm) = [0.043 ± 0.003 ⋅ height (cm)] + 0.644 ± 0.419; R² = 0.642, p < 0.001. These equations, along with the minimum and maximum length for each Broselow Tape color, were used to define color-coded normal ranges for each REBOA landing zone and access site.
Conclusion: Knowledge of the access vessel and occlusion zone diameters in pediatric patients is crucial for future research and application of REBOA in this population. Furthermore, an adapted Broselow Tape including these measurements would assist in appropriate sheath and balloon catheter selection in emergent settings.