Elsevier

Surgery

Volume 153, Issue 6, June 2013, Pages 848-856
Surgery

Original Communication
Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock

https://doi.org/10.1016/j.surg.2012.12.001Get rights and content

Background

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging technique in trauma; however, the physiologic sequelae have not been well quantified. The objectives of this study were to characterize the burden of reperfusion and organ dysfunction of REBOA incurred during 30 or 90 min of class IV shock in a survivable porcine model of hemorrhage.

Methods

After induction of shock, animals were randomized into 4 groups (n = 6): 30 min of shock alone (30-Shock) or with REBOA (30-REBOA) and 90 min of shock alone (90-Shock) or with REBOA (90-REBOA). Cardiovascular homeostasis was then restored with blood, fluid, and vasopressors for 48 h. Outcomes included mean central aortic pressure (MCAP), lactate concentration, organ dysfunction, histologic evaluation, and resuscitation requirements.

Results

Both REBOA groups had greater MCAPs throughout their shock phase compared to controls (P < .05) but accumulated a significantly greater serum lactate burden, which returned to control levels by 150 min in the 30-REBOA groups and 320 min in the 90-REBOA group. There was a greater level of renal dysfunction and evidence of liver necrosis seen in the 90-REBOA group compared to the 90-Shock group. There was no evidence of cerebral or spinal cord necrosis in any group. The 90-REBOA group required more fluid resuscitation than the 90-Shock group (P = .05).

Conclusion

REBOA in shock improves MCAP and is associated with a greater lactate burden; however, this lactate burden returned to control levels within the study period. Ultimately, prolonged REBOA is a survivable and potentially life-saving intervention in the setting of hemorrhagic shock and cardiovascular collapse in the pig.

Section snippets

Study approval and overview

Institutional Animal Care and Use Committee approval was obtained in accordance with all applicable laws, regulations, and policies. Procedures were performed at an accredited facility (Lackland Air Force Base, San Antonio, TX) in compliance with the committee’s policies and under the supervision of a licensed veterinary staff. Female Yorkshire-Landrace crossbred swine (John Albert, Cibolo, TX) (age range, 5 to 6 months; weight range 70 to 90 kg) were housed at the facility for 7 days before

Baseline characteristics and mortality

The baseline characteristics of the 4 study groups (n = 6/group), are shown in Table I. Time 0 occurred at the start of the hemorrhage phase and served as the reference point for all reported time points and values. There was no significant difference in weight or volume of hemorrhage (per kg) used to induce shock. Measures of perfusion and organ function were also similar among the groups. There were 2 deaths: 1 animal died in the 30-Shock group during the hemorrhage phase and another animal

Discussion

This study characterized the physiologic sequelae of zone 1 REBOA in the setting of class IV shock compared to shock alone for either 30 or 90 min. After the controlled hemorrhage, both REBOA groups had greater central aortic pressure and cerebral tissue oxygen levels than did shock-alone animals. These effects were achieved at the expense of a greater increase in serum lactate concentration after balloon deflation, as a consequence of visceral and lower extremity reperfusion. Lactate

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Supported by the US Air Force, Clinical Research Division, Lackland AF Base, San Antonio, TX.

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