Michael Lallemand, MD1, Donald Moe, MD1, John McClellan, MD1, Joshua Smith, DO1, Leo Daab, MD1, Shannon Marko, DVM1, Nam Tran, MD2, Benjamin Starnes, MD2, Matthew Martin, MD1. 1Madigan Army Medical Center, 2University of Washington
Objectives: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as a rescue maneuver for unstable patients with non-compressible torso hemorrhage. Early animal and human data is promising, but have mostly studied isolated major arterial or solid organ/pelvic injuries. The efficacy of REBOA in the setting a major abdominal venous injury is unknown. Our objective was to examine the use of REBOA in a large animal model of major abdominal venous injury, and characterize any impact on the hemodynamics, rate and volume of hemorrhage, and survival.
Methods: Ten adult swine (35-55kg) underwent controlled 35% blood volume hemorrhage and then an ischemia/reperfusion injury protocol to produce shock physiology. Animals were randomly assigned to either a control arm with resuscitation only (N=5) or a treatment (REBOA) arm (N=5). An injury was created in the proximal right common iliac vein. Bleeding was allowed for 60 seconds and the balloon was then inflated in the REBOA arm. Vitals and hemodynamics were recorded for 45 minutes or until death. Balloon placement and blood loss was verified via post-mortem, and bleeding rate calculated.
Results: All animals demonstrated significant shock physiology at the time of randomization. There were no differences between control versus REBOA animals in baseline MAP (42 vs 50), pH (7.29 vs 7.26), lactate (6.2 vs 6.5), or INR (1.2 vs 1.35, all p=NS). All animals developed hypotension with the initial venous hemorrhage, but the REBOA animals demonstrated immediate significant improvements in MAP (50.6 vs 97.2, p=0.04), that was sustained at all time points. There was a difference in survival between the groups, with a mean survival time of 4.1 minutes for controls (100% died) versus 40.0 minutes for REBOA (p<0.01). All but one REBOA animals survived to study completion. There was no difference in total blood loss between the two arms (mean 630 cc for both), the rate of bleeding was significantly lower in the REBOA animals (control 197 cc/min vs REBOA 18 cc/min, p=0.02).
Conclusions: In the setting of a major abdominal venous injury, the occlusion of arterial inflow via REBOA greatly improved hemodynamics and significantly lengthened survival time. Although total blood loss was similar between groups, the rate of bleeding was markedly decreased with REBOA. REBOA appears effective even for central venous injuries and provides a sustained period of stabilization and window for surgical intervention.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79684
Program Number: MSS15
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium