Radiofrequency Identification of the ER-REBOA : Confirmation of Placement Without Fluoroscopy Presented by: LT Lyndsey E. Wessels

Transcription

1 Radiofrequency Identification of the ER-REBOA : Confirmation of Placement Without Fluoroscopy Presented by: LT Lyndsey E. Wessels Naval Medical Center San Diego

2 Disclosures I have no personal or institutional financial disclosures to declare. There are no personal financial interests in any products related to this presentation. The views expressed in this presentation are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government

3 Learning Objectives Potentially survivable death on the battlefield Non-compressible hemorrhage What is REBOA? Development of ER-REBOA Current product limitations- why did I become involved? Using RFID as a novel tool for detection of placement Limitations of RFID Directions for future research

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7 Preventable civilian death In ,790 individuals died after traumatic injury The National Academies of Sciences estimated up to 20% of these deaths may have been preventable A recent data has shown this number may be too low as up to 38% of pre-hospital death was determined to be secondary to hemorrhage and likely preventable. National Center for Injury Prevention and Control

8 Non-compressible Hemorrhage Non-compressible hemorrhage What is it? Junctional vs torso Specific anatomic injury Non-compressible torso hemorrhage is a leading cause of potentially survivable death in the prehospital setting Pre-hospital capability has plateaued Does not play by the Golden Hour rule Difficult to recognize in patients with high physiologic reserve

9 What is REBOA? Vs.

10 Why and Where to Place REBOA Blunt trauma Penetrating trauma Aortic Zone Contraindications to placement

11 What is REBOA?

12 Development of the ER-REBOA

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15 Constraints of the ER-REBOA

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17 Constraints of the ER-REBOA

18 Radiofrequency Identification (RFID) Electromagnetic fields generated by the reader identifies tags attached to objects. Varies by frequency (low, high and ultra-high) as well as activity of the tag (passive vs active).

19 Radiofrequency Identification (RFID)

20 Radiofrequency Identification (RFID)

21 RFID for Detection of REBOA

22 RFID for Detection of Placement Single-arm prospective proof-of-concept experimental study RF tag from standard OR laparotomy sponge was attached to the tip of the ER-REBOA catheter Arteriotomy in previously perfused female cadaver to insert device Zone I and Zone III placement Location confirmed by x-ray Participants blinded to actual location used the Medtronic RF Assure (Minneapolis, MN) handheld detection system to predict placement in each zone

23 Zone I Results Set A Set B Set C Set D Set E Total Mean D a1 D p * Std Dev % CI Sensitivity 100% 100% 100% 100% 100% 100% Specificity 90% 60% 100% 100% 80% 86% Location of catheter tip in zone I confirmed by x-ray

24 Zone III Results Set A Set B Set C Set D Set E Total Mean D a3 D p * Std Dev % CI Sensitivity 100% 100% 100% 100% 100% 100% Specificity 70% 0% 0% 0% 10% 16% Location of catheter tip in zone III confirmed by x-ray

25 RFID for Detection of Placement RFID is reliable RFID precision is variable Precision is determined by: 1. Wavelength (frequency) of signal from tag 2. Water content in body tissue (adiposity) 3. Tortuosity of vessel 4. Environmental factors 5. Sensitivity of the detector

26 Directions for Future Research Determining optimal frequency to improve specificity Developing a tag that can fit through a 7F sheath Developing a portable reader that can withstand the environmental hazards of the forward deployed setting

27 Conclusions In the era of damage control surgery REBOA has the potential to mitigate massive NCTH and avoid unnecessary loss of life Methods for safe placement continue to evolve RFID is feasible for detection of placement in the target aortic zone Future research should focus on engineering a RFID system that is precise and compatible with the ER-REBOA

28 Non-compressible torso hemorrhage Morrison, JJ. Noncompressible torso hemorrhage. Crit Care Clin; 33(2011);

29 Thank you, LCDR James Wallace LCDR Jason Bowie LCDR William Butler Dr. Carmen Spalding CDR Michael Krzyzaniak

30 Questions?