Development of a computational fluid dynamic model to investigate the hemodynamic impact of REBOA

• DOI: 10.3389/fphys.2022.1005073
• Publication Date: 2022-10-13T06:42:55Z
• Authors: Antonio C. Renaldo; Magan R. Lane; Sophie R. Shapiro; Fahim Mobin; James E. Jordan; Timothy K. Williams; Lucas P. Neff; F. Scott Gayzik; Elaheh Rahbar
• Keywords: pressure; shear rate; Physiology; 0206 medical engineering; blood flow; QP1-981; CFD—computational fluid dynamics modeling; REBOA; 02 engineering and technology; shear stress

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving intervention for major truncal hemorrhage. Balloon-tipped arterial catheters are inserted via femoral artery to create temporary aorta, which minimizes rate internal bleeding until definitive surgery can be conducted. There growing concern over resultant hypoperfusion and potential damage tissues organs downstream REBOA. To better understand acute hemodynamic changes imposed by REBOA, we developed three-dimensional computational fluid dynamic (CFD) model under normal, hemorrhage, aortic conditions. The goal was characterize identify regions within vascular tree susceptible abnormal flow shear stress. Methods: Hemodynamic data from established porcine hemorrhage models were used build CFD model. Swine underwent 20% controlled randomized receive full or partial occlusion. Using CT scans, generated pig-specific geometry physiologically relevant inlet outlet pressure boundary conditions match in vivo data. By assuming non-Newtonian properties, pressure, velocity, stresses quantified cardiac cycle. Results: We observed significant rise blood (∼147 mmHg) proximal resulted increased stress ascending aorta. Specifically, high levels subclavian arteries (22.75 Pa). Alternatively, at site wall low (0.04 ± 9.07E-4 Pa), but oscillations (oscillatory index 0.31). Comparatively, REBOA elevated 84.14 19.50 Pa reduced oscillations. Our numerical simulations congruent 5% averaged experimental Conclusion: This first our knowledge quantify identified areas near arteries. Future studies needed determine optimal design parameters control devices that minimize perturbations shear.