Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model: A pilot study

Kaeli J. Yamashiro, Andrew M. Wishy, Carl A. Beyer, Harris W. Kashtan, Laura A. Galganski, J. Kevin Grayson, M. Austin Johnson, Jacob T. Stephenson, A. Francois Trappey

Research output: Contribution to journalArticle

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has not been studied in children. We hypothesized that REBOA was feasible and would improve hemorrhage control and survival time, compared to no aortic occlusion, in a pediatric swine liver injury model. Methods: Pediatric swine were randomized to Zone 1 REBOA or no intervention (control). Piglets underwent a partial liver amputation and free hemorrhage followed by either REBOA or no intervention for 30 min, then a damage control laparotomy and critical care for 4 h. Results: Compared to control piglets (n = 5), REBOA piglets (n = 6) had less blood loss (34.0 ± 1.6 vs 61.3 ± 2.5 mL/kg, p < 0.01), higher end hematocrit (28.1 ± 2.1 vs 17.1 ± 4.1%, p = 0.03), higher end creatinine (1.4 ± 0.1 vs 1.2 ± 0.1 mg/dL, p = 0.05), higher end ALT and AST (56 ± 4 vs 32 ± 6 U/L, p = 0.01 and 155 ± 26 vs 69 ± 25 U/L, p = 0.05) and required more norepinephrine during critical care (1.4 ± 0.3 vs 0.3 ± 0.3 mg/kg, p = 0.04). All REBOA piglets survived, whereas 2 control piglets died, p = 0.10. Conclusion: In pediatric swine, 30 min of REBOA is feasible, decreases blood loss after liver injury and may improve survival. Level of evidence: Level 1.

Original languageEnglish (US)
JournalJournal of pediatric surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Balloon Occlusion
Aorta
Swine
Pediatrics
Liver
Wounds and Injuries
Critical Care
Hemorrhage
Amputation
Hematocrit
Laparotomy
Creatinine
Norepinephrine

Keywords

  • Pediatric abdominal trauma
  • Pediatric resuscitation balloon occlusion of the aorta
  • Pediatric trauma animal model
  • Resuscitative balloon occlusion of the aorta

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Yamashiro, K. J., Wishy, A. M., Beyer, C. A., Kashtan, H. W., Galganski, L. A., Grayson, J. K., ... Trappey, A. F. (Accepted/In press). Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model: A pilot study. Journal of pediatric surgery. https://doi.org/10.1016/j.jpedsurg.2019.10.013

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model : A pilot study. / Yamashiro, Kaeli J.; Wishy, Andrew M.; Beyer, Carl A.; Kashtan, Harris W.; Galganski, Laura A.; Grayson, J. Kevin; Johnson, M. Austin; Stephenson, Jacob T.; Trappey, A. Francois.

In: Journal of pediatric surgery, 01.01.2019.

Research output: Contribution to journalArticle

Yamashiro, Kaeli J. ; Wishy, Andrew M. ; Beyer, Carl A. ; Kashtan, Harris W. ; Galganski, Laura A. ; Grayson, J. Kevin ; Johnson, M. Austin ; Stephenson, Jacob T. ; Trappey, A. Francois. / Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model : A pilot study. In: Journal of pediatric surgery. 2019.
@article{e188f7a8a15c40dfacda15c2df49b09d,
title = "Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model: A pilot study",
abstract = "Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has not been studied in children. We hypothesized that REBOA was feasible and would improve hemorrhage control and survival time, compared to no aortic occlusion, in a pediatric swine liver injury model. Methods: Pediatric swine were randomized to Zone 1 REBOA or no intervention (control). Piglets underwent a partial liver amputation and free hemorrhage followed by either REBOA or no intervention for 30 min, then a damage control laparotomy and critical care for 4 h. Results: Compared to control piglets (n = 5), REBOA piglets (n = 6) had less blood loss (34.0 ± 1.6 vs 61.3 ± 2.5 mL/kg, p < 0.01), higher end hematocrit (28.1 ± 2.1 vs 17.1 ± 4.1{\%}, p = 0.03), higher end creatinine (1.4 ± 0.1 vs 1.2 ± 0.1 mg/dL, p = 0.05), higher end ALT and AST (56 ± 4 vs 32 ± 6 U/L, p = 0.01 and 155 ± 26 vs 69 ± 25 U/L, p = 0.05) and required more norepinephrine during critical care (1.4 ± 0.3 vs 0.3 ± 0.3 mg/kg, p = 0.04). All REBOA piglets survived, whereas 2 control piglets died, p = 0.10. Conclusion: In pediatric swine, 30 min of REBOA is feasible, decreases blood loss after liver injury and may improve survival. Level of evidence: Level 1.",
keywords = "Pediatric abdominal trauma, Pediatric resuscitation balloon occlusion of the aorta, Pediatric trauma animal model, Resuscitative balloon occlusion of the aorta",
author = "Yamashiro, {Kaeli J.} and Wishy, {Andrew M.} and Beyer, {Carl A.} and Kashtan, {Harris W.} and Galganski, {Laura A.} and Grayson, {J. Kevin} and Johnson, {M. Austin} and Stephenson, {Jacob T.} and Trappey, {A. Francois}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jpedsurg.2019.10.013",
language = "English (US)",
journal = "Journal of Pediatric Surgery",
issn = "0022-3468",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a pediatric swine liver injury model

T2 - A pilot study

AU - Yamashiro, Kaeli J.

AU - Wishy, Andrew M.

AU - Beyer, Carl A.

AU - Kashtan, Harris W.

AU - Galganski, Laura A.

AU - Grayson, J. Kevin

AU - Johnson, M. Austin

AU - Stephenson, Jacob T.

AU - Trappey, A. Francois

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has not been studied in children. We hypothesized that REBOA was feasible and would improve hemorrhage control and survival time, compared to no aortic occlusion, in a pediatric swine liver injury model. Methods: Pediatric swine were randomized to Zone 1 REBOA or no intervention (control). Piglets underwent a partial liver amputation and free hemorrhage followed by either REBOA or no intervention for 30 min, then a damage control laparotomy and critical care for 4 h. Results: Compared to control piglets (n = 5), REBOA piglets (n = 6) had less blood loss (34.0 ± 1.6 vs 61.3 ± 2.5 mL/kg, p < 0.01), higher end hematocrit (28.1 ± 2.1 vs 17.1 ± 4.1%, p = 0.03), higher end creatinine (1.4 ± 0.1 vs 1.2 ± 0.1 mg/dL, p = 0.05), higher end ALT and AST (56 ± 4 vs 32 ± 6 U/L, p = 0.01 and 155 ± 26 vs 69 ± 25 U/L, p = 0.05) and required more norepinephrine during critical care (1.4 ± 0.3 vs 0.3 ± 0.3 mg/kg, p = 0.04). All REBOA piglets survived, whereas 2 control piglets died, p = 0.10. Conclusion: In pediatric swine, 30 min of REBOA is feasible, decreases blood loss after liver injury and may improve survival. Level of evidence: Level 1.

AB - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has not been studied in children. We hypothesized that REBOA was feasible and would improve hemorrhage control and survival time, compared to no aortic occlusion, in a pediatric swine liver injury model. Methods: Pediatric swine were randomized to Zone 1 REBOA or no intervention (control). Piglets underwent a partial liver amputation and free hemorrhage followed by either REBOA or no intervention for 30 min, then a damage control laparotomy and critical care for 4 h. Results: Compared to control piglets (n = 5), REBOA piglets (n = 6) had less blood loss (34.0 ± 1.6 vs 61.3 ± 2.5 mL/kg, p < 0.01), higher end hematocrit (28.1 ± 2.1 vs 17.1 ± 4.1%, p = 0.03), higher end creatinine (1.4 ± 0.1 vs 1.2 ± 0.1 mg/dL, p = 0.05), higher end ALT and AST (56 ± 4 vs 32 ± 6 U/L, p = 0.01 and 155 ± 26 vs 69 ± 25 U/L, p = 0.05) and required more norepinephrine during critical care (1.4 ± 0.3 vs 0.3 ± 0.3 mg/kg, p = 0.04). All REBOA piglets survived, whereas 2 control piglets died, p = 0.10. Conclusion: In pediatric swine, 30 min of REBOA is feasible, decreases blood loss after liver injury and may improve survival. Level of evidence: Level 1.

KW - Pediatric abdominal trauma

KW - Pediatric resuscitation balloon occlusion of the aorta

KW - Pediatric trauma animal model

KW - Resuscitative balloon occlusion of the aorta

UR - http://www.scopus.com/inward/record.url?scp=85076104985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85076104985&partnerID=8YFLogxK

U2 - 10.1016/j.jpedsurg.2019.10.013

DO - 10.1016/j.jpedsurg.2019.10.013

M3 - Article

C2 - 31787320

AN - SCOPUS:85076104985

JO - Journal of Pediatric Surgery

JF - Journal of Pediatric Surgery

SN - 0022-3468

ER -