Resuscitative Endovascular Balloon Occlusion of the Aorta（REBOA） in A Swine Model of Iliac Artery Hemorrhage under the Guidance of Portable Ultrasound

Abstract

Background: The major challenge of applying Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the pre-hospital setting is to accurately place the balloon in. To evaluate the effects of applying portable ultrasound to guide REBOA for iliac artery hemostasis.Methods: We first established a swine model of hemorrhage by percutaneously puncture the right iliac artery under the guidance of portable ultrasound. Then we randomly divided the swine into two groups. We recorded systolic pressure (SP), diastolic pressure (DP), heart rate (HR), and the maximum depth of the ascites at baseline (T1), free bleeding for the 30s (T2), bleeding for 10min (T3), and bleeding for 30min (T4). Immediately after T2, we performed REBOA under the guidance of portable ultrasound in the intervention group and manual extracorporeal compression by dry gauze in the control group. We collected total blood loss at T4.Results: There were 11 swine included in the analysis (intervention group=6, control group=5). The characteristics of the two groups were similar at T1. After punctured the right iliac artery, hemorrhagic shock appeared in both groups at T2 - BP and DP fell, HR elevated, and the maximum depth of the ascites increased. After performing REBOA, SP(in mmHg) in the intervention group significantly increased to 97.17±11.92 at T3 and remained stable throughout T4; while SP in the control group kept decreasing and reached 62.40±3.44 at T4. A similar trend was found in DP. HR(in bpm) in the intervention group increased from 101.50±5.39 in T2 to 111.83±7.39 in T3 and stabilized at 113.83±5.49 in T4; in the control group, it kept increasing from 103.20±3.70 in T2 to 132.40±3.98 in T4. The maximum depth of the ascites increased between T2 and T4 in both groups, but significantly slower in the intervention group (at T4 3.50±0.36cm vs 5.14±0.35cm, P<0.05). The total blood loss was significantly less in the intervention group (1245.23±190.07g) than in the control group (2605.63±291.67g).Conclusions: Performing REBOA under the guidance of portable ultrasound can improve the effectiveness of iliac artery hemostasis and have great potential to save lives in pre-hospital settings.