Comparison of Intermittent and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in a Porcine (Sus scrofa) Model of Non- Compressible Torso Hemorrhage
Technical Report,20 Sep 2018,17 Oct 2019
DAVID GRANT USAF MEDICAL CENTER TRAVIS AFB CA TRAVIS AFB
Pagination or Media Count:
Objectives Partial resuscitative endovascular balloon occlusion of the aorta pREBOA and intermittent-REBOA iREBOA are techniques to extend the therapeutic duration of REBOA by balloon titration for distal flow or cyclical balloon inflationdeflation to allow transient distal flow, respectively. We hypothesized that manually-titrated pREBOA would reduce blood losses and ischemic burden when compared to iREBOA. Material and methods Following 20 blood volume controlled hemorrhage, 10 anesthetized pigs underwent uncontrolled hemorrhage from the right iliac artery and vein. Once in hemorrhagic shock, animals underwent 15 minutes of complete Zone 1 REBOA followed by 75 minutes of either pREBOA or iREBOA N5group. After 90 minutes, definitive hemorrhage control was obtained, animals were resuscitated with the remaining collected blood, and then received 2 hours of critical care.Results There were no differences in mortality. Animals randomized to iREBOA spent a larger portion of the time at full occlusion when compared to pREBOA 74.0 plus or minus 5.5 versus 30.0 plus or minus 20.0, respectively p0.01. While the average blood pressure during the intervention period was equivalent between groups, this was offset by large fluctuations in blood pressure and significantly more rescue occlusions for hypotension with iREBOA. Despite lower maximum aortic flow rates, the pREBOA group tolerated a greater total amount of distal aortic flow during the intervention period median IQR 20.9 20.1-23.0L vs 9.8 6.8-10.3L p0.03 with equivalent abdominal blood losses. Final plasma lactate and creatinine concentrations were equivalent, although iREBOA animals had increased duodenal edema on histology.
- Medicine and Medical Research