Use of bilobed partial resuscitative endovascular balloon occlusion of the aorta is logistically superior in prolonged management of a highly lethal aortic injury

Jevgenia Zilberman-Rudenko, Brandon Behrens, Belinda McCully, Elizabeth N. Dewey, Sawyer G. Smith, James M. Murphy, Andrew Goodman, Samantha J. Underwood, Elizabeth A. Rick, Brianne M. Madtson, Michelle E. Thompson, Jacob J. Glaser, John B. Holcomb, Martin A. Schreiber

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA. METHODS: Anesthetized (40-50 kg) swine randomized to control (no intervention), ER-REBOA, or pREBOA-PRO underwent supraceliac aortic injury. The REBOA groups underwent catheter placement into zone 1 with initial balloon inflation to full occlusion for 10 minutes followed by gradual deflation to achieve and subsequently maintain half of the baseline below-the-balloon mean arterial pressure (MAP). Physiologic data and blood samples were collected at baseline and then hourly. At 4 hours, the animals were euthanized, total blood loss and urine output were recorded, and tissue samples were collected. RESULTS: Baseline physiologic data and basic laboratories were similar between groups. Compared with control, interventions similarly prolonged survival from a median of 18 minutes to over 240 minutes with comparable mortality trends. Blood loss was similar between partial ER-REBOA (41%) and pREBOA-PRO (51%). Partial pREBOA-PRO required a significantly lower number of intraaortic balloon adjustments (10 ER-REBOA vs. 3 pREBOA-PRO, p < 0.05) to maintain the target below-the-balloon MAP. The partial ER-REBOA group developed significantly increased hypercapnia, fibrin clot formation on TEG, liver inflammation, and IL-10 expression compared with pREBOA-PRO. CONCLUSION: In this highly lethal aortic injury model, use of bilobed pREBOA-PRO for a 4-hour partial aortic occlusion was logistically superior to unilobed ER-REBOA. It required less intraaortic balloon adjustments to maintain target MAP and resulted in less inflammation.

Original languageEnglish (US)
Pages (from-to)464-473
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number3
DOIs
StatePublished - Sep 1 2020

Keywords

  • Hemorrhage control
  • Inflammation
  • Noncompressible truncal hemorrhage
  • Partial REBOA
  • Resuscitative endovascular balloon occlusion of the aorta

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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