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Forty-Minute Endovascular Aortic Occlusion Increases Survival in an Experimental Model of Uncontrolled Hemorrhagic Shock Caused by Abdominal Trauma

Avaro, Jean-Philippe MD, PhD; Mardelle, Vincent MD; Roch, Antoine MD, PhD; Gil, Celine MD; de Biasi, Cécile MD; Oliver, Manuela MD; Fusai, Therry MD, PhD; Thomas, Pascal MD, PhD

Journal of Trauma-Injury Infection & Critical Care: September 2011 - Volume 71 - Issue 3 - pp 720-726
doi: 10.1097/TA.0b013e318221a94a
Original Article

Background: To evaluate the feasibility of aortic balloon catheter occlusion in intra-abdominal hemorrhage.

Methods: Effects of transfemoral diaphragmatic aortic balloon occlusion (ABO) have been evaluated in 25 pigs. The animals were submitted to incontrollable hemorrhage by a splenic trauma. Group 1 (n = 9) received fluid resuscitation with normal saline (NS) without aortic occlusion; group 2 (n = 8) underwent 60 minutes ABO and NS. Groups 3 (n = 4) and 4 (n = 4) underwent ABO during 40 minutes and 60 minutes, respectively, NS, and splenectomy.

Results: Aortic balloon location was adequate in all animals. ABO increased the portion of 2-hour survivors significantly (7/16 vs. 0/9; p = 0.03). ABO increased mean arterial blood pressures (p < 0.05). There was a significant decrease of bleeding and volume of fluid resuscitation (p < 0.05) in ABO groups. Blood potassium and lactate levels at death were significantly higher in groups 2 and 4 compared with those of the control group: 29 ± 0.54 and 6.08 mmol/L ± 0.44 mmol/L versus 4.16 mmol/L ± 0.35 mmol/L (p < 0.02), and 11.39 mmol/L ± 0.37 mmol/L and 9.59 mmol/L ± 1.19 mmol/L versus 6.43 mmol/L ± 0.57 mmol/L (p < 0.001), respectively. There were no significant differences between group 3 and the control group: 4.83 mmol/L ± 0.32 mmol/L versus 6.43 mmol/L ± 0.57 mmol/L and 5.2 mmol/L ± 0.13 mmol/L versus 4.16 mmol/L ± 0.35 mmol/L, respectively. At necropsy, there were no significant differences in terms of visceral (bowel and kidney) ischemia between the different experimental groups.

Conclusion: A 40-minute ABO followed by surgical damage control improved survival in this animal model of uncontrolled hemorrhagic shock caused by abdominal trauma. ABO could be considered for the management of severe abdominal trauma.

From the Service de Chirurgie Thoracique (J.-P.A.), Hôpital d'Instruction des Armées A. Laveran, Marseille, France; Département d'Anesthésie Réanimation (V.M., C.G.), Hôpital d'Instruction des Armées A. Laveran, Marseille, France; Service de Réanimation Médicale (A.R.), Hôpital Nord, Université de la Méditerranée-APHM, Marseille, France; Laboratoire d'Anatomopathologie (C.D.B.), Hôpital d'Instruction des Armées A. Laveran, Marseille, France; Laboratoire de Biochimie (M.O.), Hôpital d'Instruction des Armées A. Laveran, Marseille, France; Institut de Médecine Tropicale du Service de Santé des Armées (T.F.), Marseille, France; and Service de Chirurgie Thoracique (P.-A.T.), Hôpital Nord, Université de la Méditerranée-APHM, Marseille, France.

Submitted for publication December 31, 2010.

Accepted for publication April 27, 2011.

Address for reprints: Jean-Philippe Avaro, MD, Service de Chirurgie Thoracique, Hôpital d'Instruction des Armées A. Laveran, BP 60149, 13384 Marseille cedex 13, France; email: avarojp@orange.fr.

© 2011 Lippincott Williams & Wilkins, Inc.