Endovascular Perfusion Augmentation for Critical Care (EPACC) as a Resuscitative Adjunct in a Swine (Sus scrofa) Polytrauma Model of Ischemia Reperfusion Injury
Technical Report,25 Aug 2016,21 Dec 2017
DAVID GRANT USAF MEDICAL CENTER TRAVIS AFB CA TRAVIS AFB United States
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Objectives Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA is an emerging technology to augment proximal blood pressure during the resuscitation of patients with non-compressible torso hemorrhage. Currently, the choice of aortic placement, zone 1versus zone 3, depends upon injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1versus Zone 3REBOA placement, and the degree of hemodynamic instability upon reperfusion following intervention. Methods Anesthetized swine underwent controlled hemorrhage of 25 total blood volume, followed by 45 minutes of Zone 1REBOA, Zone 3 REBOA, or no intervention control. They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p 0.05.ResultsThere were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1animals when compared to Zone 3 animals 127.91.3 mmHg versus 53.41.1 mmHg, and greater in Zone 3 animals when compared to control animals 42.90.9 mmHg. Lactate concentrations were significantly higher in Zone 1animals 9.60.4 mmolL when compared to Zone 3 animals 5.10.3mmolL and control animals 4.2 0.8 mmolL.Conclusion In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared to Zone 1REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1REBOA placement may be more efficacious regardless of injury pattern, while Zone 3 should only be reserved for relatively stable patients with ongoing distal hemorrhage.
- Medicine and Medical Research