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

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 sought to adapt the Broselow™ Tape method to estimation of 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. 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; 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.