A contemporary assessment of devices for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): resource-specific options per level of care

Purpose: Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation. Methods: We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device. Results: Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda®-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty®-45 and LeMaitre®-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda®-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon®. ER-REBOA™, Fogarty®, LeMaitre®, REBOA Balloon®, and Rescue Balloon™ are provided with external length marks to assist blind positioning. Conclusion: In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty®, and LeMaitre®, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50® has several features that facilitate use and reduce the risk of malplacement or vessel damage

ClimBar : An Integrated Approach to Evaluate and Utilize Genetic Diversity

European agriculture anticipates an unprecedented combination of stress factors, production threats and quality needs due to climate change. Various regions of Europe will be affected differently. Barley & wheat domestication, and landrace formation in Europe, were under very different climates than those emerging now. Alleles needed for sustainable, resilient, quality yields in a changed climate are likely not combined in current haplotypes of elite barley cultivars. These alleles are likely found in diverse landraces and wild relatives in the Mediterranean basin and Fertile Crescent -- areas that prefigure expected climate change. New precision, high-throughput phenotyping tools are essential to find trait-allele associations needed for future-climate breeding. Combining genetics, genomics, modelling, molecular biology, morphology, and physiology, ClimBar takes an interdisciplinary approach to develop a strategy for breeding an increased resilience to climate change in barley. ClimBar, a new project under the framework of FACCE ERA-NET Plus Joint Programming Initiative on Climate Smart Agriculture, will identify genome regions, genes, and alleles conferring the traits needed to breed resilient barley varieties adapted to the climatic conditions predicted for 2070 in different European environments. Adapted, resilient germplasm created using ClimBar data, tools and models will provide food-chain security, economic stability and environmental sustainability. Website: http://plen.ku.dk/english/research/plant_soil/breeding/quality/climbar