Effects of Extended Lower Extremity Cooling Following Zone 3 REBOA in a Porcine Hemorrhage Model

Harris W. Kashtan, Meryl A. Simon, Carl A. Beyer, Andrew Wishy, Guillaume L. Hoareau, J. Kevin Grayson, M. Austin Johnson

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: External cooling of ischemic limbs has been shown to have a significant protective benefit for durations up to 4 hours. MATERIALS AND METHODS: It was hypothesized that this benefit could be extended to 8 hours. Six swine were anesthetized and instrumented, then underwent a 25% total blood volume hemorrhage. Animals were randomized to hypothermia or normothermia followed by 8 hours of Zone 3 resuscitative endovascular balloon occlusion of the aorta, then resuscitation with shed blood, warming, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. RESULTS: There were no significant differences between groups at baseline. There were no significant differences between creatine kinase in the hypothermia group when compared to the normothermia group (median [IQR] = 15,206 U/mL [12,476-19,987] vs 23,027 U/mL [18,745-26,843]); P = 0.13) at the end of the study. Similarly, serum myoglobin was also not significantly different in the hypothermia group after 8 hours (7,345 ng/mL [5,082-10,732] vs 5,126 ng/mL [4,720-5,298]; P = 0.28). No histologic differences were observed in hind limb skeletal muscle. CONCLUSION: While external cooling during prolonged Zone 3 resuscitative endovascular balloon occlusion of the aorta appears to decrease ischemic muscle injury, this benefit appears to be time dependent. As the ischemic time approaches 8 hours, the benefit from hypothermia decreases.

Original languageEnglish (US)
Pages (from-to)42-49
Number of pages8
JournalMilitary medicine
Volume185
Issue number1
DOIs
StatePublished - Jan 7 2020

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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    Kashtan, H. W., Simon, M. A., Beyer, C. A., Wishy, A., Hoareau, G. L., Grayson, J. K., & Johnson, M. A. (2020). Effects of Extended Lower Extremity Cooling Following Zone 3 REBOA in a Porcine Hemorrhage Model. Military medicine, 185(1), 42-49. https://doi.org/10.1093/milmed/usz306