248: Resuscitative Endovascular Balloon Occlusion of the Aorta Improves Survival in Lethal Hemorrhage
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
Pagination or Media Count:
Learning Objectives Resuscitative Endovascular Balloon Occlusion of the Aorta REBOA using generic balloon catheters placed into the descending aorta under fluoroscopy has been used to treat hemorrhagic shock in animal models. We tested a new non-image guided 7F ER-REBOA catheter Pryor Medical Arvada, CO for its potential to improve survival in a 100 lethal model of hemorrhagic shock. We hypothesized that ER-REBOA, placed without fluoroscopic guidance, improves survival. Methods Spontaneously breathing, consciously sedated, sexually mature male Sinclair pigs undergone computerized exponential hemorrhage of 65 of their blood volume over 1 hour via an arterial line. Animals were then randomized into groups of 7 animals each including negative control NC, no resuscitation positive control PC, immediate transfusion of shed blood TSB ER30 30 min of ERREBOA then TSB ER60, 60 min of ER-REBOA then TSB ER, 60 min of ERREBOA with TSB after 30 min of REBOA. After balloon deflation, epinephrine was given if mean arterial pressure was under 40 mm Hg. Up to 20 min of mechanical ventilation FiO2 .21, RR 12, TV 10 mlkg, ZEEP was provided if animal suffered respiratory arrest. Animals were monitored for 240 min post-hemorrhage or until death. Survival was assessed via Kaplan-Meier analysis. Balloon placement was verified via post-mortem CT scan and at necropsy. Results ER-REBOA was placed successfully in 100 of cases without fluoroscopy. Survival in the NC and PC groups was 0 and 71 respectively. Analysis showed significantly higher survival in the ER-REBOA groups 100 in ER30 and ER60 groups and 86 in ER p0.001. Epinephrine was given to 47 PC animals and to 67, 77, and 27 animals in ER30, ER60, and ER groups respectively. Ventilation support was given to 17, 27, and 37 in the ER30, ER60, and ER groups and to 27 in the PC group respectively.
- Anatomy and Physiology
- Medicine and Medical Research