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

Markov, Nickolay P.; Percival, Thomas; Morrison, Jonathan J.; Ross, James D.; Scott, Daniel; Spencer, Jerry R.; Rasmussen, Todd E.

doi:10.1016/j.surg.2012.12.001

Cited by 159 publications

(99 citation statements)

References 16 publications

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“…Based on these findings, it was proposed that the maximum REBOA is 60 minutes or fewer. 11 Findings from the current study confirm that 60 minutes of REBOA with either the commercially available or the newly designed device is recoverable in this model, with a normalization of acidosis within 24 hours of balloon deflation.…”

Section: Context Of Previous Researchsupporting

confidence: 74%

“…10,11 In brief, 35% of blood volume (total circulatory volume of the pig calculated as 66 mL/kg) was withdrawn through the catheter in the femoral artery, half taken over 7 minutes and the remaining half over 13 minutes. To avoid splenic autotransfusion, animals were subjected to ongoing hemorrhage at a rate of 0.15 mL/kg per minute for an additional 10 minutes to ensure hemorrhagic shock was maintained.…”

Section: Hemorrhage Phasementioning

confidence: 99%

“…Markov et al 11 recently characterized the ischemic threshold of REBOA in the setting of shock comparing 30 minutes to 90 minutes of aortic occlusion in a 48-hour survival model. Using circulating markers, mortality, and histology, Markov et al demonstrated that 90 minutes of REBOA was survivable, although it was associated with severe physiologic derangement and nonreversible end-organ damage.…”

Section: Context Of Previous Researchmentioning

confidence: 99%

“…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. In addition, REBOA is currently constrained by the requirement of fluoroscopy to guide the wire and balloon positioning.…”

mentioning

confidence: 99%

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

Scott

Eliason

Villamaria

et al. 2013

Journal of Trauma and Acute Care Surgery

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122

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Section: Context Of Previous Researchsupporting

confidence: 74%

Section: Hemorrhage Phasementioning

confidence: 99%

Section: Context Of Previous Researchmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

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

Scott

Eliason

Villamaria

et al. 2013

Journal of Trauma and Acute Care Surgery

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122

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show abstract

“…Prolonged REBOA in a swine model was found to be a potentially life saving intervention in the setting of haemorrhagic shock and cardiovascular collapse. 65 Early reports in patients with pelvic fracture have suggested that REBOA can increase the systolic blood pressure and can be a life saving manoeuvre. Further work in this field will outline exactly how long the REBOA needs to be in place and in which patients it has the greatest advantage.…”

Section: The Futurementioning

confidence: 99%

(iv) The initial assessment and early management of patients with severe pelvic ring injuries

Acharya

Forward

2014

Orthopaedics and Trauma

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Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage

Jansen,

Hudson,

Cochran

et al. 2023

JAMA

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ImportanceBleeding is the most common cause of preventable death after trauma.ObjectiveTo determine the effectiveness of resuscitative endovascular balloon occlusion of the aorta (REBOA) when used in the emergency department along with standard care vs standard care alone on mortality in trauma patients with exsanguinating hemorrhage.Design, Setting, and ParticipantsPragmatic, bayesian, randomized clinical trial conducted at 16 major trauma centers in the UK. Patients aged 16 years or older with exsanguinating hemorrhage were enrolled between October 2017 and March 2022 and followed up for 90 days.InterventionPatients were randomly assigned (1:1 allocation) to a strategy that included REBOA and standard care (n = 46) or standard care alone (n = 44).Main Outcomes and MeasuresThe primary outcome was all-cause mortality at 90 days. Ten secondary outcomes included mortality at 6 months, while in the hospital, and within 24 hours, 6 hours, or 3 hours; the need for definitive hemorrhage control procedures; time to commencement of definitive hemorrhage control procedures; complications; length of stay; blood product use; and cause of death.ResultsOf the 90 patients (median age, 41 years [IQR, 31-59 years]; 62 [69%] were male; and the median Injury Severity Score was 41 [IQR, 29-50]) randomized, 89 were included in the primary outcome analysis because 1 patient in the standard care alone group declined to provide consent for continued participation and data collection 4 days after enrollment. At 90 days, 25 of 46 patients (54%) had experienced all-cause mortality in the REBOA and standard care group vs 18 of 43 patients (42%) in the standard care alone group (odds ratio [OR], 1.58 [95% credible interval, 0.72-3.52]; posterior probability of an OR &gt;1 [indicating increased odds of death with REBOA], 86.9%). Among the 10 secondary outcomes, the ORs for mortality and the posterior probabilities of an OR greater than 1 for 6-month, in-hospital, and 24-, 6-, or 3-hour mortality were all increased in the REBOA and standard care group, and the ORs were increased with earlier mortality end points. There were more deaths due to bleeding in the REBOA and standard care group (8 of 25 patients [32%]) than in standard care alone group (3 of 18 patients [17%]), and most occurred within 24 hours.Conclusions and RelevanceIn trauma patients with exsanguinating hemorrhage, a strategy of REBOA and standard care in the emergency department does not reduce, and may increase, mortality compared with standard care alone.Trial Registrationisrctn.org Identifier: ISRCTN16184981

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

Cited by 159 publications

References 16 publications

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

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

(iv) The initial assessment and early management of patients with severe pelvic ring injuries

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage

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