Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock

Russo, Rachel M.; Neff, Lucas P.; Lamb, Christopher; Cannon, Jeremy W.; Galante, Joseph M.; Clement, Nathan F.; Grayson, J.; Williams, Timothy K.

doi:10.1016/j.jamcollsurg.2016.04.037

Cited by 134 publications

(121 citation statements)

References 39 publications

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“…In a porcine hemorrhagic shock model, Russo et al . showed that partial balloon occlusion of the aorta (pREBOA) resulted in more physiologically tolerable hemodynamic and ischemic changes compared with complete occlusion [24]. Therefore, we believe it is important with a standardized procedure in REBOA to include either a balloon deflation regime or pREBOA.…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

et al. 2017

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BackgroundSevere postpartum hemorrhage occurs in 1/1000 women giving birth. This condition is often dramatic and may be life threatening. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has in recent years been introduced as a novel treatment for hemorrhagic shock. We present a series of fluoroscopy-free REBOA for controlling life threatening postpartum hemorrhage.MethodsIn 2008 an ‘aortic occlusion kit’ was assembled and used in three Norwegian university hospitals. The on-call interventional radiologist (IR) was to be contacted with a response time < 30 minutes in case of life threatening PPH. Demographics and characteristics were noted from the medical records.ResultsThis retrospective study includes 36 patients treated with fluoroscopy-free REBOA for controlling severe postpartum hemorrhage in the years 2008–2015. The REBOA success rate was 100% and no patients died from REBOA related complications. Uterine artery embolization was performed in 17 (47%) patients and a hysterectomy in 16 (44%) patients. A short (11cm) introducer length was strongly associated with iliac artery thrombus formation (ρ = 0.50, P = 0.002). In addition, there was a strong negative correlation between uterine artery embolization and hysterectomy (ρ = -0.50, P = 0.002).ConclusionsOur Norwegian experience indicates the clinical safety and feasibility of REBOA in life threatening PPH. Also, REBOA can be used in an emergency situation without the use of fluoroscopy with a high degree of technical success. It is important that safety implementation of REBOA is established, especially through limited aortic balloon occlusion time and a thorough balloon deflation regime.

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Section: Discussionmentioning

confidence: 99%

Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

et al. 2017

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“…Previous large animal studies have confirmed its efficacy at preventing early death from exsanguination, with 100% survival during the “pre-hospital” intervention phase. 16, 17 However, the duration of REBOA is finite due to the adverse consequences of prolonged complete aortic occlusion on both proximal and distal vascular beds. 1, 11 This poses a significant challenge in scenarios where prolonged intervention is required, such as extended transport distances, prolonged care in austere environments, or mass casualty situations.…”

Section: Discussionmentioning

confidence: 99%

Automated variable aortic control versus complete aortic occlusion in a swine model of hemorrhage

Williams

Neff

Johnson

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Future endovascular hemorrhage control devices will require features that mitigate the adverse effects of vessel occlusion. Permissive regional hypoperfusion (PRH) with variable aortic control (VAC) is a novel strategy to minimize hemorrhage and reduce the ischemic burden of complete aortic occlusion (AO). The objective of this study was to compare PRH with VAC to AO in a lethal model of hemorrhage. Methods Twenty-five swine underwent cannulation of the supraceliac aorta, with diversion of aortic flow through an automated extracorporeal circuit. After creation of uncontrolled liver hemorrhage, animals were randomized to 90 minutes of treatment: Control (full, unregulated flow; n=5) AO (no flow; n=10), and PRH with VAC (dynamic distal flow initiated after 20 minutes of AO; n=10). In the PRH group, distal flow rates were regulated between 100–300mL/min based on a desired, preset range of proximal mean arterial pressure (MAP). At 90 minutes, damage control surgery, resuscitation, and restoration of full flow ensued. Critical care continued for 4.5 hours or until death. Hemodynamic parameters and markers of ischemia were recorded. Results Study survival was 0%, 50%, and 90% for control, AO, and VAC respectively (p<0.01) (Figure). During intervention, VAC resulted in more physiologic proximal MAP (84mmHg±18 vs. 105±9mmHg, p<0.01) and higher renal blood flow than AO animals (p=0.02). During critical care, VAC resulted in higher proximal MAP (73 mmHg±8 vs. 50 mmHg±6, p<0.01), carotid and renal blood flow (p<0.01), lactate clearance (p<0.01), and urine output (p<0.01) than AO despite requiring half the volume of crystalloids to maintain proximal MAP ≥50 mmHg (p<0.01). Conclusion Permissive regional hypoperfusion with variable aortic control minimizes the adverse effects of distal ischemia, optimizes proximal pressure to the brain and heart, and prevents exsanguination in this model of lethal hemorrhage. These findings provide foundational knowledge for the continued development of this novel paradigm and inform next generation endovascular designs.

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“…As mentioned, REBOA is only a temporary solution and a definitive bleeding control must follow. One of the major problems of REBOA is the ischemia-reperfusion organ injury followed by multiple organ failure that might be prevented by short REBOA time, intermittent REBOA (iREBOA), Zone III REBOA and new methods as partial REBOA (pREBOA) described lately [67, 75, 76]. …”

Section: Methodsmentioning

confidence: 99%

Pelvic trauma: WSES classification and guidelines

et al. 2017

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Complex pelvic injuries are among the most dangerous and deadly trauma related lesions. Different classification systems exist, some are based on the mechanism of injury, some on anatomic patterns and some are focusing on the resulting instability requiring operative fixation. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic impairment of pelvic ring function and the associated injuries. The management of pelvic trauma patients aims definitively to restore the homeostasis and the normal physiopathology associated to the mechanical stability of the pelvic ring. Thus the management of pelvic trauma must be multidisciplinary and should be ultimately based on the physiology of the patient and the anatomy of the injury. This paper presents the World Society of Emergency Surgery (WSES) classification of pelvic trauma and the management Guidelines.

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Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock

Cited by 134 publications

References 39 publications

Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

Fluoroscopy-free Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for controlling life threatening postpartum hemorrhage

Automated variable aortic control versus complete aortic occlusion in a swine model of hemorrhage

Pelvic trauma: WSES classification and guidelines

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