Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock

Guillaume L. Hoareau, Timothy K. Williams, Anders J. Davidson, Rachel M. Russo, Sarah Ashley E. Ferencz, Lucas P. Neff, J. Kevin Grayson, Ian J. Stewart, Michael Johnson

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

INTRODUCTION: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. MATERIALS AND METHODS: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300 mL/min after 20 minutes of complete AO). After 90 minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. RESULTS: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180 minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. CONCLUSIONS: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.

Original languageEnglish (US)
Pages (from-to)e298-e302
JournalMilitary medicine
Volume184
Issue number5-6
DOIs
StatePublished - May 1 2019

Fingerprint

Hemorrhagic Shock
Balloon Occlusion
Aorta
Swine
Angiotensin II
Serum
Therapeutic Uses
Critical Care
Aldosterone
Renin
Resuscitation
Hydrocortisone
Ischemia
Kidney
Liver
Wounds and Injuries

Keywords

  • aldosterone
  • angiotensin
  • cortisol
  • REBOA
  • renin

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Hoareau, G. L., Williams, T. K., Davidson, A. J., Russo, R. M., Ferencz, S. A. E., Neff, L. P., ... Johnson, M. (2019). Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock. Military medicine, 184(5-6), e298-e302. https://doi.org/10.1093/milmed/usy287

Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock. / Hoareau, Guillaume L.; Williams, Timothy K.; Davidson, Anders J.; Russo, Rachel M.; Ferencz, Sarah Ashley E.; Neff, Lucas P.; Grayson, J. Kevin; Stewart, Ian J.; Johnson, Michael.

In: Military medicine, Vol. 184, No. 5-6, 01.05.2019, p. e298-e302.

Research output: Contribution to journalArticle

Hoareau, GL, Williams, TK, Davidson, AJ, Russo, RM, Ferencz, SAE, Neff, LP, Grayson, JK, Stewart, IJ & Johnson, M 2019, 'Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock', Military medicine, vol. 184, no. 5-6, pp. e298-e302. https://doi.org/10.1093/milmed/usy287
Hoareau GL, Williams TK, Davidson AJ, Russo RM, Ferencz SAE, Neff LP et al. Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock. Military medicine. 2019 May 1;184(5-6):e298-e302. https://doi.org/10.1093/milmed/usy287
Hoareau, Guillaume L. ; Williams, Timothy K. ; Davidson, Anders J. ; Russo, Rachel M. ; Ferencz, Sarah Ashley E. ; Neff, Lucas P. ; Grayson, J. Kevin ; Stewart, Ian J. ; Johnson, Michael. / Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock. In: Military medicine. 2019 ; Vol. 184, No. 5-6. pp. e298-e302.
@article{2bca851c65f84d00bcadb3a90b96d4bc,
title = "Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock",
abstract = "INTRODUCTION: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. MATERIALS AND METHODS: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300 mL/min after 20 minutes of complete AO). After 90 minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. RESULTS: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180 minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. CONCLUSIONS: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.",
keywords = "aldosterone, angiotensin, cortisol, REBOA, renin",
author = "Hoareau, {Guillaume L.} and Williams, {Timothy K.} and Davidson, {Anders J.} and Russo, {Rachel M.} and Ferencz, {Sarah Ashley E.} and Neff, {Lucas P.} and Grayson, {J. Kevin} and Stewart, {Ian J.} and Michael Johnson",
year = "2019",
month = "5",
day = "1",
doi = "10.1093/milmed/usy287",
language = "English (US)",
volume = "184",
pages = "e298--e302",
journal = "Military Medicine",
issn = "0026-4075",
publisher = "Association of Military Surgeons of the US",
number = "5-6",

}

TY - JOUR

T1 - Endocrine Effects of Simulated Complete and Partial Aortic Occlusion in a Swine Model of Hemorrhagic Shock

AU - Hoareau, Guillaume L.

AU - Williams, Timothy K.

AU - Davidson, Anders J.

AU - Russo, Rachel M.

AU - Ferencz, Sarah Ashley E.

AU - Neff, Lucas P.

AU - Grayson, J. Kevin

AU - Stewart, Ian J.

AU - Johnson, Michael

PY - 2019/5/1

Y1 - 2019/5/1

N2 - INTRODUCTION: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. MATERIALS AND METHODS: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300 mL/min after 20 minutes of complete AO). After 90 minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. RESULTS: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180 minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. CONCLUSIONS: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.

AB - INTRODUCTION: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. MATERIALS AND METHODS: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300 mL/min after 20 minutes of complete AO). After 90 minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. RESULTS: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180 minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. CONCLUSIONS: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.

KW - aldosterone

KW - angiotensin

KW - cortisol

KW - REBOA

KW - renin

UR - http://www.scopus.com/inward/record.url?scp=85066236896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85066236896&partnerID=8YFLogxK

U2 - 10.1093/milmed/usy287

DO - 10.1093/milmed/usy287

M3 - Article

C2 - 30371879

AN - SCOPUS:85066236896

VL - 184

SP - e298-e302

JO - Military Medicine

JF - Military Medicine

SN - 0026-4075

IS - 5-6

ER -