Resuscitative endovascular balloon occlusion of the aorta for major abdominal venous injury in a porcine hemorrhagic shock model

Michael S. Lallemand, Donald M. Moe, John M. McClellan, Joshua P. Smith, Leo Daab, Shannon Marko, Nam Tran, Benjamin Starnes, Matthew J. Martin

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rescue maneuver for unstable patients with noncompressible hemorrhage below the diaphragm. The efficacy of REBOA in the setting a major abdominal venous injury is unknown. Our objective was to examine the use of REBOA in a large animal model of major abdominal venous injury and characterize any impact on the hemodynamics, rate and volume of hemorrhage, and survival. Methods: Ten swine (35-55 kg) underwent a controlled and validated hemorrhage and ischemia/reperfusion injury protocol to produce shock physiology. Animals were randomly assigned to a control arm (N = 5) or a treatment (REBOA) arm (N = 5). An injury was then created in the common iliac vein. Bleeding was allowed for 60 seconds and the balloon was then inflated in the REBOA arm. Hemodynamics were recorded for 45 minutes or until death. Blood loss was verified post-mortem and bleeding rate calculated. Results: All animals demonstrated shock physiology at the time of randomization. There were no differences between control versus REBOA animals in baseline mean arterial pressure (42 vs. 50), pH (7.29 vs. 7.26), lactate (6.19 vs. 6.26), or INR (1.2 vs. 1.3, all p = NS). REBOA animals demonstrated immediate improvements in mean arterial pressure (50.6 vs. 97.2, p = 0.04). The mean survival time was 4.1 minutes for controls (100% died) versus 40.1 minutes for REBOA (p < 0.01). There was no difference in total blood loss (mean 630 mL for both). The rate of bleeding was significantly lower in the REBOA animals (control 197 mL/min vs. REBOA 14 mL/min, p = 0.02). Conclusion: In the setting of an abdominal venous injury, REBOA improved hemodynamics and lengthened survival time. Blood loss was similar between groups but the rate of bleeding was markedly decreased with REBOA. REBOA appears effective for central venous injuries and provides a sustained period of stabilization and window for surgical intervention.

Original languageEnglish (US)
Pages (from-to)230-236
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume83
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Balloon Occlusion
Abdominal Injuries
Hemorrhagic Shock
Aorta
Swine
Hemorrhage
Hemodynamics
Shock
Arterial Pressure
Iliac Vein
International Normalized Ratio
Wounds and Injuries
Random Allocation
Diaphragm
Reperfusion Injury

Keywords

  • hemorrhage control
  • Noncompressible truncal hemorrhage
  • porcine model
  • REBOA
  • trauma
  • venous hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Resuscitative endovascular balloon occlusion of the aorta for major abdominal venous injury in a porcine hemorrhagic shock model. / Lallemand, Michael S.; Moe, Donald M.; McClellan, John M.; Smith, Joshua P.; Daab, Leo; Marko, Shannon; Tran, Nam; Starnes, Benjamin; Martin, Matthew J.

In: Journal of Trauma and Acute Care Surgery, Vol. 83, No. 2, 01.08.2017, p. 230-236.

Research output: Contribution to journalArticle

Lallemand, Michael S. ; Moe, Donald M. ; McClellan, John M. ; Smith, Joshua P. ; Daab, Leo ; Marko, Shannon ; Tran, Nam ; Starnes, Benjamin ; Martin, Matthew J. / Resuscitative endovascular balloon occlusion of the aorta for major abdominal venous injury in a porcine hemorrhagic shock model. In: Journal of Trauma and Acute Care Surgery. 2017 ; Vol. 83, No. 2. pp. 230-236.
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AU - Lallemand, Michael S.

AU - Moe, Donald M.

AU - McClellan, John M.

AU - Smith, Joshua P.

AU - Daab, Leo

AU - Marko, Shannon

AU - Tran, Nam

AU - Starnes, Benjamin

AU - Martin, Matthew J.

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N2 - Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rescue maneuver for unstable patients with noncompressible hemorrhage below the diaphragm. The efficacy of REBOA in the setting a major abdominal venous injury is unknown. Our objective was to examine the use of REBOA in a large animal model of major abdominal venous injury and characterize any impact on the hemodynamics, rate and volume of hemorrhage, and survival. Methods: Ten swine (35-55 kg) underwent a controlled and validated hemorrhage and ischemia/reperfusion injury protocol to produce shock physiology. Animals were randomly assigned to a control arm (N = 5) or a treatment (REBOA) arm (N = 5). An injury was then created in the common iliac vein. Bleeding was allowed for 60 seconds and the balloon was then inflated in the REBOA arm. Hemodynamics were recorded for 45 minutes or until death. Blood loss was verified post-mortem and bleeding rate calculated. Results: All animals demonstrated shock physiology at the time of randomization. There were no differences between control versus REBOA animals in baseline mean arterial pressure (42 vs. 50), pH (7.29 vs. 7.26), lactate (6.19 vs. 6.26), or INR (1.2 vs. 1.3, all p = NS). REBOA animals demonstrated immediate improvements in mean arterial pressure (50.6 vs. 97.2, p = 0.04). The mean survival time was 4.1 minutes for controls (100% died) versus 40.1 minutes for REBOA (p < 0.01). There was no difference in total blood loss (mean 630 mL for both). The rate of bleeding was significantly lower in the REBOA animals (control 197 mL/min vs. REBOA 14 mL/min, p = 0.02). Conclusion: In the setting of an abdominal venous injury, REBOA improved hemodynamics and lengthened survival time. Blood loss was similar between groups but the rate of bleeding was markedly decreased with REBOA. REBOA appears effective for central venous injuries and provides a sustained period of stabilization and window for surgical intervention.

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