Conversion of Abdominal Aortic and Junctional Tourniquet (AAJT) to Infrarenal Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is Safe and Practical in a Swine Hemorrhage Model
San Antonio Uniformed Services Health Education Consortium San Antonio United States
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Two methods of controlling pelvic and inguinal hemorrhage are the Abdominal Aortic and Junctional Tourniquet AAJT and Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA. The AAJT can be applied quickly, but prolonged use may damage the bowel, inhibit ventilation, and obstruct surgical access. REBOA requires technical proficiency, but has fewer complications. Safe conversion of AAJT to REBOA would allow for field hemorrhage control with mitigation of the morbidity associated with prolonged AAJT use. Methods Yorkshire male swine n17, 70-90kgs underwent controlled 40 hemorrhage. Subsequently, AAJT was placed on the abdomen and inflated. After one hour, animals were allocated to an additional 30 minutes of AAJT inflation, continuous AAJT, CA, REBOA placement with the AAJT inflated, immediate REBOA IR, or REBOA placement following AAJT removal subsequent REBOA SR. Following removal, animals were observed for 3.5 hours. Results. No significant differences in survival, blood pressure, or laboratory values were found following intervention. Conversion to REBOA was successful in all animals but one in the IR group. REBOA placement time was 4.32.9 min for IR and 4.11.8 min for SR p0.909. No animal had observable intestinal injury. Conclusions. Conversion of AAJT to infrarenal REBOA is safe and effective, but access may be difficult while the AAJT is applied.
- Anatomy and Physiology
- Medicine and Medical Research