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Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.

Methods

Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.

Results

Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.

Conclusions

In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

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Author information

Author notes

    Authors and Affiliations

    1. Department of War Surgery, Kirov Military Medical Academy, 6, Lebedeva Str., Saint-Petersburg, 194044, Russian Federation

      V. A. Reva, D. A. Sveklov, A. V. Denisov, S. Y. Telickiy, A. B. Seleznev, E. R. Bozhedomova & I. M. Samokhvalov

    2. R. Adams Cowley Shock Trauma Center, University of Maryland, 22 S Green St, Baltimore, MD, 21201, USA

      Y. Matsumura

    3. Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8677, Japan

      Y. Matsumura

    4. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Fakultetsgatan, 1, 702 81, Örebro, Sweden

      T. Hörer

    5. Departments of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, 2-1-16, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan

      J. Matsumoto

    6. Department of Radiology, National Hospital Organization Disaster Medical Center, Tachikawa, Tokyo, 190-0014, Japan

      J. Matsumoto

    7. Department of Vascular Surgery, South Glasgow University Hospital, 1345 Govan Rd, Glasgow, G51 4TF, UK

      J. J. Morrison

    8. The Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Birmingham, B15 2TH, UK

      J. J. Morrison

    Authors
    1. V. A. Reva
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    2. Y. Matsumura
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    7. A. B. Seleznev
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    8. E. R. Bozhedomova
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    9. J. Matsumoto
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    10. I. M. Samokhvalov
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    Corresponding author

    Correspondence to V. A. Reva.

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    Funding

    Viktor Reva and Sergey Telickiy received a Grant from the President of Russia #MK-7508.2016.7 to conduct this study.

    Conflict of interest

    Yosuke Matsumura is a clinical advisory board member of Tokai Medical Products. Jonathan Morrison is a clinical advisory board member of Prytime Medical Inc. Tal Hörer, Denis Sveklov, Alexey Denisov, Alexey Seleznev, Elvira Bozhedomova, and Igor Samokhvalov declare that they have no conflict of interest.

    Ethical approval

    All procedures performed in this experimental study were in accordance with the ethical standards of the Kirov Military Medical Academy and National Institutes of Health guide for the care and use of laboratory animals. The local institutional ethics committee approved the study (protocol no. 163/2015).

    Additional information

    V. A. Reva and Y. Matsumura contributed equally to this paper.

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    Reva, V.A., Matsumura, Y., Hörer, T. et al. Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?. Eur J Trauma Emerg Surg 44, 511–518 (2018). https://doi.org/10.1007/s00068-016-0732-z

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    • DOI: https://doi.org/10.1007/s00068-016-0732-z

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