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There's an app for that: A handheld smartphone-based infrared imaging device to assess adequacy and level of aortic occlusion during REBOA

Sokol, Kyle K. MD; Black, George E. MD; Willey, Sandra B.; Kniery, Kevin MD; Marko, Shannon T. DVM; Eckert, Matthew J. MD; Martin, Matthew J. MD

Journal of Trauma and Acute Care Surgery: January 2017 - Volume 82 - Issue 1 - p 102–108
doi: 10.1097/TA.0000000000001264
EAST 2016 Plenary Paper
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BACKGROUND Advances in thermal imaging devices have made them an appealing noninvasive point-of-care imaging adjunct in the trauma setting. We sought to assess whether a smartphone-based infrared imaging device (SBIR) could determine presence and location of aortic occlusion in a swine model. We hypothesized that various levels of aortic occlusion would transmit significantly different heat signatures at various anatomical points.

METHODS Six swine (35–50 kg) underwent sequential zone 1 (Z1) aortic cross clamping as well as zone 3 (Z3) aortic balloon occlusion (resuscitative endovascular balloon occlusion of the aorta [REBOA]). SBIR images and readings (FLIR One) were taken at five anatomic points (axilla [A], subcostal [S], umbilical [U], inguinal [I], medial malleolar [M]) and were used to determine significant thermal trends 5 minutes to 10 minutes after Z1 and Z3 occlusion. Significant (p ≤ 0.05) thermal ratio patterns were identified and compared among groups, and images were reviewed for obvious qualitative differences at the various levels of occlusion.

RESULTS Body temperatures were similar during control (CON), Z1 occlusion, and Z3 occlusion, ranging from 94.0 °F to 100.9 °F (p = 0.126). No significant temperature differences were found among A, S, U, I, M points prior to and after aortic occlusions. Among the anatomical 2-point ratios evaluated, A/M and S/M ratios were the best predictors of aortic occlusion, whether at Z1 (8.2 °F, p < 0.01; 10.9 °F, p < 0.01) or Z3 (7.3 °F, p < 0.01; 8.4 °F, p < 0.01), respectively. The best predictor of Z1 versus Z3 level of occlusion was the S/I ratio (5.2 °F, p < 0.05 vs. 3.4 °F, p = 0.27). SBIR generated qualitatively different thermal signatures among groups.

CONCLUSION SBIR was capable of detecting thermal trends during Z1 and Z3 aortic occlusion by using an anatomical 2-point thermal ratio. There were also easily recognized qualitative differences between control and occlusion images that would allow immediate determination of adequate occlusion of the aorta. SBIR represents a potential inexpensive and accurate tool for assessing perfusion, adequate REBOA placement, and even the aortic level of occlusion.

From the Department of Surgery (K.K.S., G.E.B., S.B.W., K.K., S.T.M., M.J.E., M.J.M.), Madigan Army Medical Center, Tacoma, Washington; and Trauma and Acute Care Surgery Service (M.J.M.), Legacy Emanuel Medical Center, Portland, Oregon.

Submitted: December 1, 2015, Revised: June 15, 2016, Accepted: June 29, 2016, Published online: October 31, 2016.

This study was presented at the 29th annual meeting of the Eastern Association for the Surgery of Trauma, January 13–16, 2016, in San Antonio, Texas.

This study was funded by a Defence Advanced Research Projects Agency (DARPA) grant under the “Biochronicity Project.”

The results and opinions expressed in this article are those of the authors and do not reflect the opinions or official policy of the U.S. Army or the Department of Defense.

Address for reprints: Matthew J. Martin, MD, Department of Surgery, Madigan Army Medical Center, 9040-A Fitzsimmons Avenue, Tacoma, WA 98431; email: matthew.j.martin16.mil@mail.mil.

© 2017 Lippincott Williams & Wilkins, Inc.