Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage

Jonathan J. Morrison, James Ross, Robert Houston, J. Devin B Watson, Kyle K. Sokol, Todd E. Rasmussen

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

ABSTRACT: Noncompressible torso hemorrhage is a leading cause of death in trauma, with many patients dying before definitive hemorrhage control. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct than can be used to expand the window of salvage in patients with end-stage hemorrhagic shock. The aim of this study was to evaluate the effect of continuous and intermittent REBOA (iREBOA) on mortality using a highly lethal porcine model of noncompressible torso hemorrhage. Male splenectomized pigs (70-90 kg) underwent a laparoscopic liver injury (80% resection of left lobe) followed by a 10-min free-bleed period. Animals were then divided into three groups (n = 8) for a 60-min intervention phase (n = 8): continuous occlusion (cREBOA), iREBOA, or no occlusion (nREBOA). Groups then underwent whole blood resuscitation, damage control surgery, and further critical care. Endpoints were mortality and hemodynamic and circulating measures of shock and resuscitation. Systolic blood pressure (in mmHg) at the end of the free-bleed period for cREBOA, iREBOA, and nREBOA was 31 ± 14, 48 ± 28, and 28 ± 17, respectively (P = 0.125). Following the start of the intervention phase, systolic blood pressure was higher in the iREBOA and cREBOA groups compared with the nREBOA (85 ± 37 and 96 ± 20 vs. 42 ± 4; P <0.001). Overall mortality for the cREBOA, iREBOA, and nREBOA groups was 25.0%, 37.5%, and 100.0% (P = 0.001). Resuscitative endovascular balloon occlusion of the aorta can temporize exsanguinating hemorrhage and restore life-sustaining perfusion, bridging critical physiology to definitive hemorrhage control. Prospective observational studies of REBOA as a hemorrhage control adjunct should be undertaken in appropriate groups of human trauma patients.

Original languageEnglish (US)
Pages (from-to)130-137
Number of pages8
JournalShock
Volume41
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Fingerprint

Balloon Occlusion
Torso
Aorta
Hemorrhage
Blood Pressure
Resuscitation
Mortality
Wounds and Injuries
Swine
Exsanguination
Hemorrhagic Shock
Critical Care
Observational Studies
Cause of Death
Shock
Perfusion
Hemodynamics
Prospective Studies
Liver

Keywords

  • hemorrhagic shock
  • noncompressible torso hemorrhage
  • REBOA
  • resuscitation
  • Resuscitative endovascular balloon occlusion of the aorta

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Emergency Medicine

Cite this

Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. / Morrison, Jonathan J.; Ross, James; Houston, Robert; Watson, J. Devin B; Sokol, Kyle K.; Rasmussen, Todd E.

In: Shock, Vol. 41, No. 2, 02.2014, p. 130-137.

Research output: Contribution to journalArticle

Morrison, Jonathan J. ; Ross, James ; Houston, Robert ; Watson, J. Devin B ; Sokol, Kyle K. ; Rasmussen, Todd E. / Use of resuscitative endovascular balloon occlusion of the aorta in a highly lethal model of noncompressible torso hemorrhage. In: Shock. 2014 ; Vol. 41, No. 2. pp. 130-137.
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