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

Abstract

White, Joseph M.; Cannon, Jeremy W.; Stannard, Adam; Markov, Nickolay P.; Spencer, Jerry R.; and Rasmussen, Todd E., "Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock" (2011 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. (Surgery 2011;150:400-9.)

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

“…17,18 White et al 18 demonstrated that the physiologic burden of zone I REBOA was less than that of resuscitative thoracotomy in a porcine model of 50 min of hemorrhagic shock. Animals treated with REBOA were less acidotic, had less serum lactate concentration, and required less resuscitation than animals treated with thoracotomy and aortic cross clamping.…”

A novel fluoroscopy-free, resuscitative endovascular aortic balloon occlusion system in a model of hemorrhagic shock

“…As such, REBOA may facilitate a proactive approach to aortic control ready to support the central circulation of patients at imminent risk of cardiovascular collapse. 9,10 Emerging animal evidence demonstrates the benefits of REBOA in shock, with occlusion time of up to 90 minutes generating a significant but survivable metabolic penalty. 11,12 However, today's technology requires that this adjunct be performed with a large-caliber balloon catheter passed over a wire through a large sheath.…”

Emergency Department Thoracotomy: an Update

“…The use of REBOA as a supplement during EDT has been recently proposed. In comparison to thoracotomy and clamp occlusion in an animal model, patients who underwent REBOA were less acidotic (pH, 7.35 vs. 7.24, p<0.05) and had a lower serum lactate level (4.27 vs. 6.55, p<0.05) [31]. In addition, the REBOA group required less fluid (667 vs. 2166 mL, p<0.05) and norepinephrine (0 vs. 52.1 mcg, p<0.05) during resuscitation.…”