Pediatric sized reboa catheter testing in a pulsatile aortic flow model

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the management of pediatric abdomino-pelvic hemorrhage from trauma or iatrogenic injury is limited by a lack of appropriately sized balloon catheters that can be delivered through a less than 7-Fr sheath. Methods: We bench tested the occlusion capability of eight commercially available balloon catheters deliverable through 4-Fr, 5-Fr, and 6-Fr sheaths in an anatomic pulsatile flow model of the pediatric aorta with variable luminal diameters (5 mm, 6 mm, 7 mm, 8 mm, 9 mm, 10 mm, and 12 mm). Inflated balloon migration and the deflated bal-loon’s effect on aortic flow were recorded. The flow chamber was calibrated to an approximate size-appropriate physiologic aortic blood flow. Results: Seven of the eight devices were able to occlude the test lumen diameter corresponding to their manufac-tured specifications. Deflated luminal flow restriction in the smallest test lumen was lowest in the Fogarty devices (0–3%) followed by Cordis (8–10%) and Numed (14–26%) devices. The Fogarty devices demonstrated the most distal migration (10–15 mm) followed by Numed (1–5 mm). Device migration was undetectable in the Cordis devices. Conclusion: There are commercially available balloon catheters, deliverable through smaller than 7-Fr sheaths, which can occlude pediatric sized aortic test lumens in the setting of physiologic pulsatile flow. While the use of these catheters for occlusion represents off-label use, these results will help inform future research, device devel-opment, and practice in the field of pediatric REBOA.