Elsevier

Surgery

Volume 150, Issue 3, September 2011, Pages 400-409
Surgery

Society of University Surgeons
Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock

Presented at the 6th Annual Academic Surgical Congress Huntington Beach, CA, February 1-3, 2011.
https://doi.org/10.1016/j.surg.2011.06.010Get rights and content

Background

Noncompressible torso hemorrhage is the leading cause of potentially preventable death on the modern battlefield. The objective of this study is to characterize resuscitative aortic balloon occlusion (BO) compared to thoracotomy with aortic clamping in a model of hemorrhagic shock.

Methods

A total of 18 swine (3 groups; 6 animals/group) were used in this study. Swine in class IV shock underwent no aortic occlusion (NO), thoracotomy and clamp occlusion (CO), or endovascular BO. Animals in the NO group underwent direct placement of a temporary vascular shunt (TVS) at the injury site, whereas animals in the CO and BO groups underwent aortic occlusion before TVS placement. Hemodynamic and physiologic measures were collected.

Results

The central aortic pressure, carotid blood flow and brain oxygenation as measured by oximetry increased in the CO and BO groups compared to the NO group (P < .05). During resuscitation, the BO group was less acidotic than the CO group (pH,7.35 vs 7.24; P < .05) with a lower serum lactate level (4.27 vs 6.55; P < .05) and pCO2 level (43.5 vs 49.9; P < .05). During resuscitation, the BO group required less fluid (667 mL vs 2,166 mL; P < .05) and norepinephrine (0 mcg vs 52.1 mcg; P < .05) than the CO group.

Conclusion

Resuscitative aortic BO increases central perfusion pressures with less physiologic disturbance than thoracotomy with aortic clamping in a model of hemorrhagic shock. Endovascular BO of the aorta should be explored further as an option in the management of noncompressible torso hemorrhage.

Section snippets

Study approval and overview

Institutional Animal Care and Use Committee (IACUC) approval was obtained from our institution before the study was undertaken. Procedures were performed at an accredited facility (Lackland Air Force Base, San Antonio, TX) in compliance with IACUC policies and under the supervision of a licensed veterinary staff. Female Yorkshire–Landrace crossbred swine (John Albert, Cibolo, TX) (age range, 5–6 months; weight range, 70–95 kg) were housed at the facility 7 days before the protocol to allow for

Outcomes and perfusion measurements

There was no difference in mortality among the CO, BO, or NO groups (0%, 0%, and 17%, respectively; P = not significant [NS]). The single fatality in the NO group occurred during the resuscitation phase with no obvious cause of death at necropsy. Total shed blood volume was greatest in the NO group by protocol design, given the increased time of ongoing hemorrhage in this group (CO: 1,998 ± 307 mL; BO: 2,087 ± 105; NO: 2,353 ± 194 mL; P = .03).

All vascular shunts remained patent after placement

Discussion

This study demonstrates the feasibility of resuscitative aortic BO in a large animal model of end-stage hemorrhagic shock. Endovascular BO resulted in increases in central aortic pressure, carotid flow, and partial oxygenation pressure of the brain that were equal to those increases associated with open clamping of the aorta. In contrast to resuscitative thoracotomy with aortic clamping, findings from this study demonstrate that endovascular BO results in less acidosis and lower resuscitative

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    The results of this study and opinions expressed in the manuscript are the views of the authors and are not to be construed as official statements by or as a reflection of the views of the U.S. Department of the Air Force, the U.S. Department of the Army, or the U.S. Department of Defense.

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