Aortic Hemostasis and Resuscitation Advanced REBOA for NCTH and Reversal of HiTCA

The majority of combat and civilian casualties are due to severe uncontrolled, non-compressible hemorrhage resulting in cardiovascular collapse. Current resuscitation techniques, including cardiopulmonary resuscitation (CPR), thoracotomy, and aortic cross-clamping to reverse hemorrhage-induced traumatic cardiac arrest (HiTCA), are very invasive and ineffective for austere combat casualties. Aortic Hemostasis and Resuscitation (AHR) is advanced form of resuscitative endovascular balloon occlusion of the aorta (REBOA) that has been recently shown to promote return of spontaneous circulation (ROSC). This study examines the survival benefit of AHR in otherwise fatal non-compressible torso hemorrhage (NCTH) with HiTCA. It aims to compare the efficacy of the selective aortic arch perfusion (SAAP) catheter when used with fresh whole blood or an oxygen therapeutic (HBOC). In addition, it aims to demonstrate the feasibility of the conversion from SAAP therapy to limited extra-corporeal life support (ECLS), and also to determine the impact of ECLS on critical physiology. To do this, we utilized a model of swine NCTH and HiTCA in a series of experiments in which each animal underwent a liver laceration and allowed to free bleed for five minutes through the SAAP catheter to achieve HiTCA. Then, resuscitation fluid is selectively perfused through the balloon catheter to the heart and brain, while also limiting non-compressible bleeding below the balloon. As a result, ROSC was achieved in 100 percent of the FWB animals and 86 percent of the HBOC-201 animals (p=0.12). Overall survival (t = 320 min) was 92 percent in the FWB group and 67 percent in the HBOC-201 group (p=0.12). This study shows that the SAAP catheter is an effective method of hemorrhage control by promoting ROSC and sustaining life in pre-hospital transport. AHR promotes hemodynamic stability and has the potential to fill a critical unmet gap in military and civilian trauma care.