John Kuckelman, Morgan Barron, Donald Moe, Michael Derickson, Cody Phillips, Joseph Kononchik, Michael Lallemand, Shannon Marko, Matthew Eckert, Matthew Martin. Madigan Army Medical Center
INTRODUCTION: Non-compressible truncal hemorrhage can be temporarily controlled using resuscitative endovascular occlusion of the aorta (REBOA). Prolonged ischemia has limited REBOA application, but intermittent inflation schedules may be a strategy to mitigate this problem.
METHODS: A lethal pelvic arteriovenous injury was created in twenty-eight adult swine. Animals were randomized to control (n=7), 60min full REBOA (FR, n=5), time-based intermittent REBOA (iRT, n=7), and pressure-based REBOA (iRP, n=9). Intermittent groups had initial inflation for 15min, followed by 10min inflation:3min deflation cycles (iRT) or full re-inflation for 10 min if mean arterial pressure (MAP)<40mmHg (iRP). Experiments were concluded after 120min or MAP<20mmHg.
RESULTS: Intermittent REBOA animals all survived to 120min compared to 15 min for controls and 63 min for FR (p<0.001). After 60 minutes, FR animals were more hypotensive (MAP 20mmHg vs 80mmHg (iRP) and 100mmHg (iRT), p<0.001), had lower cardiac output (1.06mL/min vs 5.1L/min (iRP) and 8.2L/min (iRT), p<0.001), had higher lactic acidosis (12.5mg/dL compared to 8.5mg/dL in (iRP), p=0.02), and less firm clot formation on ROTEM (64mm vs 69mm (iRP) and 69mm (iRT), p=0.04) than the intermittent groups. iRP was superior to iRT with less acidosis at 120min (pH 7.28 vs 7.12, p=0.02 and lactate 11.9mg/dL vs 16.3mg/dL, p=0.04) and decreased whole blood resuscitation (452cc vs 646cc, p=0.05). Blood loss as determined by post mortem clot weight was significantly higher in the controls (2.0 kg) compared to iRT and iRP (1.16 kg and 1.23 kg, p<0.01) and not significantly different from FR (0.87, p=0.10).
CONCLUSIONS: Intermittent REBOA is a feasible technique to maintain supraceliac hemorrhage control while decreasing the detrimental effects of distal ischemia in a swine model. Schedules based on a MAP threshold are superior to time-based regimens.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87121
Program Number: MSS02
Presentation Session: Full-Day Military Surgical Symposium – Basic Science Presentations
Presentation Type: MSSPodium