Location is everything: The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta

Emily M. Tibbits, Guillaume L. Hoareau, Meryl A. Simon, Anders J. Davidson, Erik S. Desoucy, E. Robert Faulconer, Joseph J. Dubose, Lucas P. Neff, J. Kevin Grayson, Timothy K. Williams, Michael Johnson

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVES Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.

Original languageEnglish (US)
Pages (from-to)101-107
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume85
Issue number1
DOIs
StatePublished - Jul 1 2018

Fingerprint

Balloon Occlusion
Aorta
Hemodynamics
Hemorrhage
Reperfusion
Swine
Torso
Euthanasia
Hemorrhagic Shock
Wounds and Injuries
Critical Care
Blood Volume
Resuscitation
Lactic Acid
Blood Pressure
Technology

Keywords

  • Endovascular
  • intra-aortic balloon
  • resuscitation
  • shock

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Location is everything : The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta. / Tibbits, Emily M.; Hoareau, Guillaume L.; Simon, Meryl A.; Davidson, Anders J.; Desoucy, Erik S.; Robert Faulconer, E.; Dubose, Joseph J.; Neff, Lucas P.; Grayson, J. Kevin; Williams, Timothy K.; Johnson, Michael.

In: Journal of Trauma and Acute Care Surgery, Vol. 85, No. 1, 01.07.2018, p. 101-107.

Research output: Contribution to journalArticle

Tibbits, EM, Hoareau, GL, Simon, MA, Davidson, AJ, Desoucy, ES, Robert Faulconer, E, Dubose, JJ, Neff, LP, Grayson, JK, Williams, TK & Johnson, M 2018, 'Location is everything: The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta', Journal of Trauma and Acute Care Surgery, vol. 85, no. 1, pp. 101-107. https://doi.org/10.1097/TA.0000000000001858
Tibbits, Emily M. ; Hoareau, Guillaume L. ; Simon, Meryl A. ; Davidson, Anders J. ; Desoucy, Erik S. ; Robert Faulconer, E. ; Dubose, Joseph J. ; Neff, Lucas P. ; Grayson, J. Kevin ; Williams, Timothy K. ; Johnson, Michael. / Location is everything : The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 101-107.
@article{76e8c971c84746f494075a323ea41051,
title = "Location is everything: The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta",
abstract = "OBJECTIVES Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS Eighteen anesthetized swine underwent controlled hemorrhage of 25{\%} total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.",
keywords = "Endovascular, intra-aortic balloon, resuscitation, shock",
author = "Tibbits, {Emily M.} and Hoareau, {Guillaume L.} and Simon, {Meryl A.} and Davidson, {Anders J.} and Desoucy, {Erik S.} and {Robert Faulconer}, E. and Dubose, {Joseph J.} and Neff, {Lucas P.} and Grayson, {J. Kevin} and Williams, {Timothy K.} and Michael Johnson",
year = "2018",
month = "7",
day = "1",
doi = "10.1097/TA.0000000000001858",
language = "English (US)",
volume = "85",
pages = "101--107",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Location is everything

T2 - The hemodynamic effects of REBOA in Zone 1 versus Zone 3 of the aorta

AU - Tibbits, Emily M.

AU - Hoareau, Guillaume L.

AU - Simon, Meryl A.

AU - Davidson, Anders J.

AU - Desoucy, Erik S.

AU - Robert Faulconer, E.

AU - Dubose, Joseph J.

AU - Neff, Lucas P.

AU - Grayson, J. Kevin

AU - Williams, Timothy K.

AU - Johnson, Michael

PY - 2018/7/1

Y1 - 2018/7/1

N2 - OBJECTIVES Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.

AB - OBJECTIVES Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technology to augment proximal blood pressure during the resuscitation of patients with noncompressible torso hemorrhage. Currently, placement choice, supraceliac (Zone 1) versus infrarenal (Zone 3) aorta, depends on injury patterns, but remains a highly debated topic. We sought to compare the proximal hemodynamic support provided by Zone 1 versus Zone 3 REBOA placement and the degree of hemodynamic instability upon reperfusion following intervention. METHODS Eighteen anesthetized swine underwent controlled hemorrhage of 25% total blood volume, followed by 45 minutes of Zone 1 REBOA, Zone 3 REBOA, or no intervention (control). They were then resuscitated with shed blood, aortic balloons were deflated, and 5 hours of critical care ensued prior to euthanasia. Physiologic parameters were recorded continuously, and blood was drawn for analysis at specified intervals. Significance was defined as p < 0.05. RESULTS There were no significant differences between groups at baseline or during the initial 30 minutes of hemorrhage. During the intervention period, average proximal MAP was significantly greater in Zone 1 animals when compared with Zone 3 animals (127.9 ± 1.3 vs. 53.4 ± 1.1 mm Hg) and greater in Zone 3 animals when compared with control animals (42.9 ± 0.9 mm Hg). Lactate concentrations were significantly higher in Zone 1 animals (9.6 ± 0.4 mmol/L) when compared with Zone 3 animals (5.1 ± 0.3 mmol/L) and control animals (4.2 ± 0.8 mmol/L). CONCLUSIONS In our swine model of hemorrhagic shock, Zone 3 REBOA provided minimal proximal hemodynamic support when compared with Zone 1 REBOA, albeit with less ischemic burden and instability upon reperfusion. In cases of impending hemodynamic collapse, Zone 1 REBOA placement may be more efficacious regardless of injury pattern, whereas Zone 3 should be reserved only for relatively stable patients with ongoing distal hemorrhage.

KW - Endovascular

KW - intra-aortic balloon

KW - resuscitation

KW - shock

UR - http://www.scopus.com/inward/record.url?scp=85052759136&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052759136&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000001858

DO - 10.1097/TA.0000000000001858

M3 - Article

C2 - 29965941

AN - SCOPUS:85052759136

VL - 85

SP - 101

EP - 107

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -