Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury
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While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model.
Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time.
There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 ± 0.8 versus 9.4 ± 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98–108) versus 117 (115–124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 ± 263 versus 356 ± 291 mL, P = 0.782) or density (− 406 ± 127 versus − 299 ± 175 HFU, P = 0.256).
Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA.
KeywordsResuscitative endovascular balloon occlusion of the aorta (REBOA) Blunt thoracic trauma Pulmonary contusion Poly-trauma Hemorrhagic shock
We thank SFC Casey Hicks, Mr. Carl Gibbins, Ms. Sally Knode, Ms. Amy Taylor, SSgt Sasha Palen, and SrA Natalya Clifton for their outstanding technical assistance, and the other staff of the Clinical Investigation Facility, David Grant USAF Medical Center for their support. We also thank The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. for their administrative support.
This work is supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Defense Medical Research and Development Program under Award No. W81XWH-16–2-0043. Opinions, interpretations, conclusions and recommendations are those of the authors and are not necessarily endorsed by the Department of Defense.
Compliance with ethical standards
Conflict of interest
T.K.W., M.A.J., and L.P.N. are founders and stockholders of Certus Critical Care, Inc. All the other authors report no conflicts of interest.
The views expressed in this material are those of the authors and do not reflect the official policy of the US Government, the Department of Defense, the Department of the Air Force, the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the University of California Davis, or Wake Forest University. The animals involved in this study were procured, maintained, and used in accordance with the Laboratory Animal Welfare Act of 1966, as amended, and the Guide for the Care and Use of Laboratory Animals, National Research Council. The work reported herein was performed under United States Air Force Surgeon General approved Clinical Investigation Number FDG20170021A.
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