Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock

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

Research output: Contribution to journalArticle

Abstract

Introduction: Trauma patients are predisposed to kidney injury. We hypothesized that in shock, zone 3 REBOA would increase renal blood flow (RBF) compared to control and that a period of zone 3 occlusion following zone 1 occlusion would improve renal function compared to zone 1 occlusion alone. Materials and methods: Twenty-four anesthetized swine underwent hemorrhagic shock, 45 min of zone 1 REBOA (Z1, supraceliac), zone 3 REBOA (Z3, infrarenal), or no intervention (control) followed by resuscitation with shed blood and 5 h of critical care. In a fourth group (Z1Z3), animals underwent 55 min of zone 3 REBOA following zone 1 occlusion. Physiologic parameters were recorded, blood and urine were collected at specified intervals. Results: During critical care, there were no differences in RBF between the Z1 and Z3 groups. The average RBF during critical care in Z1Z3 was significantly lower than in Z3 alone (98.2 ± 23.9 and 191.9 ± 23.7 mL/min; p = 0.046) and not different than Z1. There was no difference in urinary neutrophil gelatinase-associated lipocalin-to-urinary creatinine ratio between Z1 and Z1Z3. Animals in the Z1Z3 group had a significant increase in the ratio at the end of the experiment compared to baseline [median (IQR)] [9.2 (8.2–13.2) versus 264.5 (73.6–1174.6)]. Following Z1 balloon deflation, RBF required 45 min to return to baseline. Conclusion: Neither zone 3 REBOA alone nor zone 3 REBOA following zone 1 REBOA improved renal blood flow or function. Following zone 1 occlusion, RBF is restored to baseline levels after approximately 45 min.

Original languageEnglish (US)
JournalInjury
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Hemorrhagic Shock
Renal Circulation
Swine
Kidney
Critical Care
Wounds and Injuries
Resuscitation
Shock
Creatinine
Urine

Keywords

  • Acute kidney injury
  • Ischemia-reperfusion
  • REBOA
  • Resuscitation
  • Resuscitative endovascular balloon occlusion of the aorta
  • Trauma

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Hoareau, G. L., Tibbits, E. M., Simon, M. A., Davidson, A. J., DeSoucy, E. S., Faulconer, E. R., ... Johnson, M. (Accepted/In press). Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock. Injury. https://doi.org/10.1016/j.injury.2019.08.037

Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock. / Hoareau, Guillaume L.; Tibbits, Emily M.; Simon, Meryl A.; Davidson, Anders J.; DeSoucy, Erik S.; Faulconer, E. Robert; Grayson, J. Kevin; Stewart, Ian J.; Neff, Lucas P.; Williams, Timothy K.; Johnson, Michael.

In: Injury, 01.01.2019.

Research output: Contribution to journalArticle

Hoareau, GL, Tibbits, EM, Simon, MA, Davidson, AJ, DeSoucy, ES, Faulconer, ER, Grayson, JK, Stewart, IJ, Neff, LP, Williams, TK & Johnson, M 2019, 'Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock', Injury. https://doi.org/10.1016/j.injury.2019.08.037
Hoareau GL, Tibbits EM, Simon MA, Davidson AJ, DeSoucy ES, Faulconer ER et al. Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock. Injury. 2019 Jan 1. https://doi.org/10.1016/j.injury.2019.08.037
Hoareau, Guillaume L. ; Tibbits, Emily M. ; Simon, Meryl A. ; Davidson, Anders J. ; DeSoucy, Erik S. ; Faulconer, E. Robert ; Grayson, J. Kevin ; Stewart, Ian J. ; Neff, Lucas P. ; Williams, Timothy K. ; Johnson, Michael. / Renal effects of three endoaortic occlusion strategies in a swine model of hemorrhagic shock. In: Injury. 2019.
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abstract = "Introduction: Trauma patients are predisposed to kidney injury. We hypothesized that in shock, zone 3 REBOA would increase renal blood flow (RBF) compared to control and that a period of zone 3 occlusion following zone 1 occlusion would improve renal function compared to zone 1 occlusion alone. Materials and methods: Twenty-four anesthetized swine underwent hemorrhagic shock, 45 min of zone 1 REBOA (Z1, supraceliac), zone 3 REBOA (Z3, infrarenal), or no intervention (control) followed by resuscitation with shed blood and 5 h of critical care. In a fourth group (Z1Z3), animals underwent 55 min of zone 3 REBOA following zone 1 occlusion. Physiologic parameters were recorded, blood and urine were collected at specified intervals. Results: During critical care, there were no differences in RBF between the Z1 and Z3 groups. The average RBF during critical care in Z1Z3 was significantly lower than in Z3 alone (98.2 ± 23.9 and 191.9 ± 23.7 mL/min; p = 0.046) and not different than Z1. There was no difference in urinary neutrophil gelatinase-associated lipocalin-to-urinary creatinine ratio between Z1 and Z1Z3. Animals in the Z1Z3 group had a significant increase in the ratio at the end of the experiment compared to baseline [median (IQR)] [9.2 (8.2–13.2) versus 264.5 (73.6–1174.6)]. Following Z1 balloon deflation, RBF required 45 min to return to baseline. Conclusion: Neither zone 3 REBOA alone nor zone 3 REBOA following zone 1 REBOA improved renal blood flow or function. Following zone 1 occlusion, RBF is restored to baseline levels after approximately 45 min.",
keywords = "Acute kidney injury, Ischemia-reperfusion, REBOA, Resuscitation, Resuscitative endovascular balloon occlusion of the aorta, Trauma",
author = "Hoareau, {Guillaume L.} and Tibbits, {Emily M.} and Simon, {Meryl A.} and Davidson, {Anders J.} and DeSoucy, {Erik S.} and Faulconer, {E. Robert} and Grayson, {J. Kevin} and Stewart, {Ian J.} and Neff, {Lucas P.} and Williams, {Timothy K.} and Michael Johnson",
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AU - Hoareau, Guillaume L.

AU - Tibbits, Emily M.

AU - Simon, Meryl A.

AU - Davidson, Anders J.

AU - DeSoucy, Erik S.

AU - Faulconer, E. Robert

AU - Grayson, J. Kevin

AU - Stewart, Ian J.

AU - Neff, Lucas P.

AU - Williams, Timothy K.

AU - Johnson, Michael

PY - 2019/1/1

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N2 - Introduction: Trauma patients are predisposed to kidney injury. We hypothesized that in shock, zone 3 REBOA would increase renal blood flow (RBF) compared to control and that a period of zone 3 occlusion following zone 1 occlusion would improve renal function compared to zone 1 occlusion alone. Materials and methods: Twenty-four anesthetized swine underwent hemorrhagic shock, 45 min of zone 1 REBOA (Z1, supraceliac), zone 3 REBOA (Z3, infrarenal), or no intervention (control) followed by resuscitation with shed blood and 5 h of critical care. In a fourth group (Z1Z3), animals underwent 55 min of zone 3 REBOA following zone 1 occlusion. Physiologic parameters were recorded, blood and urine were collected at specified intervals. Results: During critical care, there were no differences in RBF between the Z1 and Z3 groups. The average RBF during critical care in Z1Z3 was significantly lower than in Z3 alone (98.2 ± 23.9 and 191.9 ± 23.7 mL/min; p = 0.046) and not different than Z1. There was no difference in urinary neutrophil gelatinase-associated lipocalin-to-urinary creatinine ratio between Z1 and Z1Z3. Animals in the Z1Z3 group had a significant increase in the ratio at the end of the experiment compared to baseline [median (IQR)] [9.2 (8.2–13.2) versus 264.5 (73.6–1174.6)]. Following Z1 balloon deflation, RBF required 45 min to return to baseline. Conclusion: Neither zone 3 REBOA alone nor zone 3 REBOA following zone 1 REBOA improved renal blood flow or function. Following zone 1 occlusion, RBF is restored to baseline levels after approximately 45 min.

AB - Introduction: Trauma patients are predisposed to kidney injury. We hypothesized that in shock, zone 3 REBOA would increase renal blood flow (RBF) compared to control and that a period of zone 3 occlusion following zone 1 occlusion would improve renal function compared to zone 1 occlusion alone. Materials and methods: Twenty-four anesthetized swine underwent hemorrhagic shock, 45 min of zone 1 REBOA (Z1, supraceliac), zone 3 REBOA (Z3, infrarenal), or no intervention (control) followed by resuscitation with shed blood and 5 h of critical care. In a fourth group (Z1Z3), animals underwent 55 min of zone 3 REBOA following zone 1 occlusion. Physiologic parameters were recorded, blood and urine were collected at specified intervals. Results: During critical care, there were no differences in RBF between the Z1 and Z3 groups. The average RBF during critical care in Z1Z3 was significantly lower than in Z3 alone (98.2 ± 23.9 and 191.9 ± 23.7 mL/min; p = 0.046) and not different than Z1. There was no difference in urinary neutrophil gelatinase-associated lipocalin-to-urinary creatinine ratio between Z1 and Z1Z3. Animals in the Z1Z3 group had a significant increase in the ratio at the end of the experiment compared to baseline [median (IQR)] [9.2 (8.2–13.2) versus 264.5 (73.6–1174.6)]. Following Z1 balloon deflation, RBF required 45 min to return to baseline. Conclusion: Neither zone 3 REBOA alone nor zone 3 REBOA following zone 1 REBOA improved renal blood flow or function. Following zone 1 occlusion, RBF is restored to baseline levels after approximately 45 min.

KW - Acute kidney injury

KW - Ischemia-reperfusion

KW - REBOA

KW - Resuscitation

KW - Resuscitative endovascular balloon occlusion of the aorta

KW - Trauma

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