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The Effects of the Duration of Aortic Balloon Occlusion on Outcomes of Traumatic Cardiac Arrest in a Porcine Model

Xu, Jiefeng*,†,‡; Shen, Peng*,†,§; Gao, Yuzhi*,†; Xia, Senlin*,†,||; Liu, Shaoyun*,†; Li, Zilong; Zhou, Guangju*,†; Xu, Yongan*,†; Zhang, Mao*,†

doi: 10.1097/SHK.0000000000001235
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ABSTRACT Aortic balloon occlusion (ABO) facilitates the success of cardiopulmonary resuscitation (CPR) in non-traumatic cardiac arrest, and is also effective in controlling traumatic hemorrhage; however, a prolonged occlusion results in irreversible organ injury and death. In this study, we investigated the effects of ABO on CPR outcomes and its optimal duration for post-resuscitation organ protection in a porcine model of traumatic cardiac arrest (TCA).

Twenty-seven male domestic pigs weighing 33 ± 4 kg were utilized. Forty percent of estimated blood volume was removed within 20 min. The animals were then subjected to 5 min of untreated ventricular fibrillation and 5 min of CPR. Coincident with the start of CPR, the animals were randomized to receive either 30-min ABO (n = 7), 60-min ABO (n = 8) or control (n = 12). Meanwhile, fluid resuscitation was initiated by the infusion of normal saline with 1.5 times of hemorrhage volume in 1 h, and finished by the reinfusion of 50% of the shed blood in another 1 h. The resuscitated animals were monitored for 6 h and observed for an additional 18 h.

During CPR, coronary perfusion pressure was significantly increased followed by a higher rate of resuscitation success in the 30 and 60-min ABO groups compared with the control group. However, post-resuscitation cardiac, neurologic dysfunction, and injuries were significantly milder accompanied with less renal and intestinal injuries in the 30-min ABO group than in the other two groups.

In conclusion, ABO augmented the efficacy of CPR after TCA, and furthermore a 30-min ABO improved post-resuscitation cardiac and neurologic outcomes without exacerbating the injuries of kidney and intestine.

*Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

Institute of Emergency Medicine, Zhejiang University, Hangzhou, China

Department of Emergency Medicine, Yuyao People's Hospital, Medical School of Ningbo University, Ningbo, China

§Department of Intensive Care Medicine, The First Hospital of Jiaxing, Jiaxing, China

||Department of Emergency Medicine, Huzhou Central Hospital, Huzhou, China

Address reprint requests to Mao Zhang, MD, PhD, Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang road, Hangzhou 310009, China. E-mail: z2jzk@zju.edu.cn

Received 17 June, 2018

Revised 10 July, 2018

Accepted 20 July, 2018

MZ is funded by the Welfare Scientific Research Project from Chinese Ministry of Health (2015SQ00050) and the Key Program Cosponsored by Zhejiang Province and National Health and Family Planning Commission of China (2018271879). GZ is funded by the Zhejiang Provincial Natural Science Foundation of China (LY17H150001). YX is funded by the Natural Science Foundation of China (81571916).

The authors report no conflicts of interest.

© 2019 by the Shock Society