Extending the golden hour

Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model

Rachel M. Russo, Timothy K. Williams, John Kevin Grayson, Christopher M. Lamb, Jeremy W. Cannon, Nathan F. Clement, Joseph M Galante, Lucas P. Neff

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

BACKGROUND: Combat-injured patients may require rapid and sustained support during transport; however, the prolonged aortic occlusion produced by conventional resuscitative endovascular balloon occlusion of the aorta (REBOA) may lead to substantial morbidity. Partial REBOA (PREBOA) may permit longer periods of occlusion by allowing some degree of distal perfusion. However, the ability of this procedure to limit exsanguination is unclear. We evaluated the impact of P-REBOA on immediate survival and ongoing hemorrhage in a highly lethal swine liver injury model. METHODS: Fifteen Yorkshire-cross swine were anesthetized, instrumented, splenectomized, and subjected to rapid 10% total blood loss followed by 30% liver amputation. Coagulopathy was created through colloid hemodilution. Randomized swine received no intervention (control), P-REBOA, or complete REBOA (C-REBOA). Central mean arterial pressure (cMAP), carotid blood flow, and blood loss were recorded. Balloons remained inflated in the P-REBOA and C-REBOA groups for 90 minutes followed by graded deflation. The study ended at 180 minutes from onset of hemorrhage or death of the animal. Survival analysis was performed, and data were analyzed using repeatedmeasures analysis of variance with post hoc pairwise comparisons. RESULTS: Mean survival times in the control, P-REBOA, and C-REBOA groups were, 25 ± 21, 86 ± 40, and 163 ± 20 minutes, respectively (p < 0.001). Blood loss was greater in the P-REBOA group than the C-REBOA or control groups, but this difference was not significant (4,722 ± 224, 3,834 ± 319, 3,818 ± 37 mL, respectively, p = 0.10). P-REBOA resulted in maintenance of near-baseline carotid blood flow and cMAP, while C-REBOA generated extreme cMAP and prolonged supraphysiologic carotid blood flow. Both experimental groups experienced profound decreases in cMAP following balloon deflation. CONCLUSION: In the setting of severe ongoing hemorrhage, P-REBOA increased survival time beyond the golden hour while maintaining cMAP and carotid flowat physiologic levels.

Original languageEnglish (US)
Pages (from-to)372-380
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume80
Issue number3
DOIs
StatePublished - 2016

Fingerprint

Balloon Occlusion
Aorta
Swine
Liver
Wounds and Injuries
Arterial Pressure
Hemorrhage
Exsanguination
Hemodilution
Colloids
Survival Analysis
Amputation
Analysis of Variance
Survival Rate
Perfusion
Maintenance
Morbidity

Keywords

  • Endovascular
  • Intra-aortic balloon
  • Resuscitation
  • Swine
  • Trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Extending the golden hour : Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. / Russo, Rachel M.; Williams, Timothy K.; Grayson, John Kevin; Lamb, Christopher M.; Cannon, Jeremy W.; Clement, Nathan F.; Galante, Joseph M; Neff, Lucas P.

In: Journal of Trauma and Acute Care Surgery, Vol. 80, No. 3, 2016, p. 372-380.

Research output: Contribution to journalArticle

Russo, Rachel M. ; Williams, Timothy K. ; Grayson, John Kevin ; Lamb, Christopher M. ; Cannon, Jeremy W. ; Clement, Nathan F. ; Galante, Joseph M ; Neff, Lucas P. / Extending the golden hour : Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 80, No. 3. pp. 372-380.
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T2 - Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model

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AU - Williams, Timothy K.

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AU - Lamb, Christopher M.

AU - Cannon, Jeremy W.

AU - Clement, Nathan F.

AU - Galante, Joseph M

AU - Neff, Lucas P.

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N2 - BACKGROUND: Combat-injured patients may require rapid and sustained support during transport; however, the prolonged aortic occlusion produced by conventional resuscitative endovascular balloon occlusion of the aorta (REBOA) may lead to substantial morbidity. Partial REBOA (PREBOA) may permit longer periods of occlusion by allowing some degree of distal perfusion. However, the ability of this procedure to limit exsanguination is unclear. We evaluated the impact of P-REBOA on immediate survival and ongoing hemorrhage in a highly lethal swine liver injury model. METHODS: Fifteen Yorkshire-cross swine were anesthetized, instrumented, splenectomized, and subjected to rapid 10% total blood loss followed by 30% liver amputation. Coagulopathy was created through colloid hemodilution. Randomized swine received no intervention (control), P-REBOA, or complete REBOA (C-REBOA). Central mean arterial pressure (cMAP), carotid blood flow, and blood loss were recorded. Balloons remained inflated in the P-REBOA and C-REBOA groups for 90 minutes followed by graded deflation. The study ended at 180 minutes from onset of hemorrhage or death of the animal. Survival analysis was performed, and data were analyzed using repeatedmeasures analysis of variance with post hoc pairwise comparisons. RESULTS: Mean survival times in the control, P-REBOA, and C-REBOA groups were, 25 ± 21, 86 ± 40, and 163 ± 20 minutes, respectively (p < 0.001). Blood loss was greater in the P-REBOA group than the C-REBOA or control groups, but this difference was not significant (4,722 ± 224, 3,834 ± 319, 3,818 ± 37 mL, respectively, p = 0.10). P-REBOA resulted in maintenance of near-baseline carotid blood flow and cMAP, while C-REBOA generated extreme cMAP and prolonged supraphysiologic carotid blood flow. Both experimental groups experienced profound decreases in cMAP following balloon deflation. CONCLUSION: In the setting of severe ongoing hemorrhage, P-REBOA increased survival time beyond the golden hour while maintaining cMAP and carotid flowat physiologic levels.

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