A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration.

Szczegóły
Abstrakt

Tytuł:: A novel partial resuscitative endovascular balloon aortic occlusion device that can be deployed in zone 1 for more than 2 hours with minimal provider titration.
Autorzy:: Kemp MT; From the Department of Surgery (M.T.K., G.K.W., A.M.W., B.E.B., R.L.O., C.A.V., K.C., H.B.A.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (R.M.R.), UC Davis Medical Center, Sacramento; US Air Force Medical Corps, 60th Medical Group (R.M.R.), Travis AFB, Fairfield, California; and Department of Surgery (H.B.A.), Northwestern University, Chicago, Illinois.
Wakam GK
Williams AM
Biesterveld BE
O'Connell RL
Vercruysse CA
Chtraklin K
Russo RM
Alam HB
Źródło:: The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2021 Mar 01; Vol. 90 (3), pp. 426-433.
Typ publikacji:: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
Język:: English
Imprint Name(s):: Original Publication: Hagerstown, MD : Lippincott, Williams & Wilkins
MeSH Terms:: Aorta*
Balloon Occlusion/*instrumentation
Endovascular Procedures/*instrumentation
Reperfusion Injury/*prevention & control
Resuscitation/*instrumentation
Shock, Hemorrhagic/*therapy
Animals ; Arterial Pressure ; Balloon Occlusion/adverse effects ; Balloon Occlusion/methods ; Disease Models, Animal ; Endovascular Procedures/adverse effects ; Endovascular Procedures/methods ; Female ; Reperfusion Injury/etiology ; Resuscitation/adverse effects ; Resuscitation/methods ; Swine
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Entry Date(s):: Date Created: 20210125 Date Completed: 20210511 Latest Revision: 20230825
Update Code:: 20240105
DOI:: 10.1097/TA.0000000000003042
PMID:: 33492106
: Czasopismo naukowe

Background: Hemorrhage is a leading cause of mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) can control hemorrhage, but distal ischemia, subsequent reperfusion injury, and the need for frequent balloon titration remain problems. Improved device design can allow for partial REBOA (pREBOA) that may provide hemorrhage control while also perfusing distally without need for significant provider titration.
Methods: Female Yorkshire swine (N = 10) were subjected to 40% hemorrhagic shock for 1 hour (mean arterial pressure [MAP], 28-32 mm Hg). Animals were then randomized to either complete aortic occlusion (ER-REBOA) or partial occlusion (novel pREBOA-PRO) without frequent provider titration or distal MAP targets. Detection of a trace distal waveform determined partial occlusion in the pREBOA-PRO arm. After 2 hours of zone 1 occlusion, the hemorrhaged whole blood was returned. After 50% autotransfusion, the balloon was deflated over a 10-minute period. Following transfusion, the animals were survived for 2 hours while receiving resuscitation based on objective targets: lactated Ringer's fluid boluses (goal central venous pressure, ≥ 6 mm Hg), a norepinephrine infusion (goal MAP, 55-60 mm Hg), and acid-base correction (goal pH, >7.2). Hemodynamic variables, arterial lactate, lactate dehydrogenase, aspartate aminotransferase, and creatinine levels were measured.
Results: All animals survived throughout the experiment, with similar increase in proximal MAPs in both groups. Animals that underwent partial occlusion had slightly higher distal MAPs. At the end of the experiment, the partial occlusion group had lower end levels of serum lactate (p = 0.006), lactate dehydrogenase (p = 0.0004) and aspartate aminotransferase (p = 0.004). Animals that underwent partial occlusion required less norepinephrine (p = 0.002), less bicarbonate administration (p = 0.006), and less fluid resuscitation (p = 0.042).
Conclusion: Improved design for pREBOA can decrease the degree of distal ischemia and reperfusion injury compared with complete aortic occlusion, while providing a similar increase in proximal MAPs. This can allow pREBOA zone-1 deployment for longer periods without the need for significant balloon titration.
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