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Resuscitative endovascular balloon occlusion of the aorta (REBOA): Comparison with immediate transfusion following massive hemorrhage in swine

Park, Timothy S. MD; Batchinsky, Andriy I. MD; Belenkiy, Slava M. MD; Jordan, Bryan S. MSN; Baker, William L.; Necsoiu, Corina N. MD; Aden, James K. PhD; Dubick, Michael A. PhD; Cancio, Leopoldo C. MD

Journal of Trauma and Acute Care Surgery: December 2015 - Volume 79 - Issue 6 - p 930–936
doi: 10.1097/TA.0000000000000877
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BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) is less invasive than emergency department thoracotomy for the treatment of massive hemorrhage. We evaluated the effects of REBOA on carotid blood flow (Qcarotid) in a porcine model of massive hemorrhage. We hypothesized that REBOA restores Qcarotid faster than reinfusion of blood.

METHODS Spontaneously breathing sedated Sinclair pigs underwent exponential hemorrhage of 65% total blood volume in 1 hour. They were randomized into three groups. Positive control (PC, n = 7) underwent immediate transfusion of shed blood. REBOA (n = 21) received a novel 7 Fr ER-REBOA catheter (Pryor Medical, Arvada, CO) placed into aortic Zone 1 via a femoral artery introducer for 30 minutes or 60 minutes, with transfusion either after deflation or midway through inflation. Negative control (n = 7) received no resuscitation. Qcarotid was recorded continuously using an ultrasonic flow probe. Survival and time between Qcarotid, min and both a stable maximal value (Qcarotid, max) and restoration of baseline flow (Qcarotid, new BL) were compared by Kaplan-Meier analysis.

RESULTS Median time to Qcarotid, max was 3.0 minutes in the REBOA group versus 9.6 minutes in the control group (p = 0.006). Median time to Qcarotid, new BL was 6.0 minutes in the REBOA group versus 20.5 minutes in the PC group (p = 0.11). Slope of the linear regression between Qcarotid, min and Qcarotid, new BL was 16.7 in REBOA and 10.4 in PC (p = 0.31). Four-hour survival was 95% (20 of 21) in the REBOA group versus 71% (5 of 7) in the PC group (p = 0.06) and 0% in the negative control group.

CONCLUSION REBOA resulted in the restoration of Qcarotid (“cerebrovascular resuscitation”) at least as rapidly as retransfusion of shed blood, with equivalent 4-hour survival. Further studies of REBOA, to include mitigation of end-organ effects and longer follow-up, are needed.

Supplemental digital content is available in the text.

From the General Surgery Service (T.S.P.), San Antonio Military Medical Center; and US Army Institute of Surgical Research (A.I.B., S.M.B., B.S.J., W.L.B., C.N.N., J.K.A., M.A.D., L.C.C.), JBSA Fort Sam Houston, San Antonio, Texas.

Submitted: February 27, 2015, Revised: September 10, 2015, Accepted: September 11, 2015.

This study was presented at the 45th annual meeting of the Western Trauma Association, March 1–6, 2015, in Telluride, Colorado.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Leopoldo C. Cancio, MD, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX; email: divego99@gmail.com.

© 2015 Lippincott Williams & Wilkins, Inc.