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Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Highly Lethal Model of Noncompressible Torso Hemorrhage

Morrison, Jonathan J.*†‡; Ross, James D.§; Houston, Robert IV‡∥; Watson, J. Devin B.‡∥; Sokol, Kyle K.‡§; Rasmussen, Todd E.‡§¶

doi: 10.1097/SHK.0000000000000085
Basic Science Aspects

ABSTRACT: Noncompressible torso hemorrhage is a leading cause of death in trauma, with many patients dying before definitive hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct than can be used to expand the window of salvage in patients with end-stage hemorrhagic shock. The aim of this study was to evaluate the effect of continuous and intermittent REBOA (iREBOA) on mortality using a highly lethal porcine model of noncompressible torso hemorrhage. Male splenectomized pigs (70–90 kg) underwent a laparoscopic liver injury (80% resection of left lobe) followed by a 10-min free-bleed period. Animals were then divided into three groups (n = 8) for a 60-min intervention phase (n = 8): continuous occlusion (cREBOA), iREBOA, or no occlusion (nREBOA). Groups then underwent whole blood resuscitation, damage control surgery, and further critical care. Endpoints were mortality and hemodynamic and circulating measures of shock and resuscitation. Systolic blood pressure (in mmHg) at the end of the free-bleed period for cREBOA, iREBOA, and nREBOA was 31 ± 14, 48 ± 28, and 28 ± 17, respectively (P = 0.125). Following the start of the intervention phase, systolic blood pressure was higher in the iREBOA and cREBOA groups compared with the nREBOA (85 ± 37 and 96 ± 20 vs. 42 ± 4; P < 0.001). Overall mortality for the cREBOA, iREBOA, and nREBOA groups was 25.0%, 37.5%, and 100.0% (P = 0.001). Resuscitative endovascular balloon occlusion of the aorta can temporize exsanguinating hemorrhage and restore life-sustaining perfusion, bridging critical physiology to definitive hemorrhage control. Prospective observational studies of REBOA as a hemorrhage control adjunct should be undertaken in appropriate groups of human trauma patients.

*The Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham; Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; The US Army Institute of Surgical Research, Fort Sam Houston; §59th Medical Wing, Lackland Air Force Base; Department of Surgery, San Antonio Military Medical Center, Fort Sam Houston, San Antonio, Texas; and The Norman M. Rich Department of Surgery, The Uniformed Services University of the Health Sciences, Bethesda, Maryland

Received 24 Sep 2013; first review completed 10 Oct 2013; accepted in final form 25 Oct 2013

Address reprint requests to Col. Todd E. Rasmussen, MD, FACS, USAF MC, US Combat Casualty Care Research Program, 722 Doughten St, Room 3, Fort Detrick, MD 21702. E-mail: todd.e.rasmussen.mil@mail.mil.

Funding was received from the US Air Force.

The authors declare no conflicts of interest.

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© 2014 by the Shock Society