Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury

Carl A. Beyer, Guillaume L. Hoareau, Harris W. Kashtan, Andrew M. Wishy, Connor Caples, Marguerite Spruce, John K. Grayson, Lucas P. Neff, Timothy K. Williams, Michael A. Johnson

Research output: Contribution to journalArticle

Abstract

Purpose: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. Methods: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. Results: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98–108) versus 117 (115–124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (− 406 ± 127 versus − 299 ± 175 HFU, P = 0.256). Conclusions: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.

Original languageEnglish (US)
JournalEuropean Journal of Trauma and Emergency Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Balloon Occlusion
Thoracic Injuries
Nonpenetrating Wounds
Hemorrhagic Shock
Aorta
Swine
Contusions
Wounds and Injuries
Thorax
Lung
Arterial Pressure
Critical Care
Blood Volume
Hemoglobins
Hemodynamics
Hemorrhage
Blood Pressure

Keywords

  • Blunt thoracic trauma
  • Hemorrhagic shock
  • Poly-trauma
  • Pulmonary contusion
  • Resuscitative endovascular balloon occlusion of the aorta (REBOA)

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Orthopedics and Sports Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury. / Beyer, Carl A.; Hoareau, Guillaume L.; Kashtan, Harris W.; Wishy, Andrew M.; Caples, Connor; Spruce, Marguerite; Grayson, John K.; Neff, Lucas P.; Williams, Timothy K.; Johnson, Michael A.

In: European Journal of Trauma and Emergency Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Beyer, Carl A. ; Hoareau, Guillaume L. ; Kashtan, Harris W. ; Wishy, Andrew M. ; Caples, Connor ; Spruce, Marguerite ; Grayson, John K. ; Neff, Lucas P. ; Williams, Timothy K. ; Johnson, Michael A. / Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury. In: European Journal of Trauma and Emergency Surgery. 2019.
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abstract = "Purpose: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. Methods: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25{\%} blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. Results: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98–108) versus 117 (115–124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (− 406 ± 127 versus − 299 ± 175 HFU, P = 0.256). Conclusions: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.",
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AU - Beyer, Carl A.

AU - Hoareau, Guillaume L.

AU - Kashtan, Harris W.

AU - Wishy, Andrew M.

AU - Caples, Connor

AU - Spruce, Marguerite

AU - Grayson, John K.

AU - Neff, Lucas P.

AU - Williams, Timothy K.

AU - Johnson, Michael A.

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Y1 - 2019/1/1

N2 - Purpose: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. Methods: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. Results: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98–108) versus 117 (115–124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (− 406 ± 127 versus − 299 ± 175 HFU, P = 0.256). Conclusions: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.

AB - Purpose: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. Methods: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. Results: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98–108) versus 117 (115–124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (− 406 ± 127 versus − 299 ± 175 HFU, P = 0.256). Conclusions: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.

KW - Blunt thoracic trauma

KW - Hemorrhagic shock

KW - Poly-trauma

KW - Pulmonary contusion

KW - Resuscitative endovascular balloon occlusion of the aorta (REBOA)

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