Introduction:
Following hemorrhage-induced traumatic cardiac arrest (TCA), the effectiveness of standard cardiopulmonary resuscitation (CPR) would be weakened or lost due to an inadequate circulating volume. Previous investigations demonstrated that aortic balloon occlusion (ABO) could control the bleeding and increase proximal organ perfusion during severe traumatic hemorrhage. In this study, we investigated the effect of ABO on the efficacy of CPR in a swine model of TCA.
Hypothesis:
ABO initiated during CPR would increase cardiac and cerebral perfusion so as to improve the outcomes of resuscitation after TCA in swine.
Methods:
Twenty-seven male domestic swine weighing 33±4 kg were utilized. Forty percent of estimated blood volume was removed within 20 mins. The animals were then subjected to 5 mins of untreated ventricular fibrillation and 5 mins of CPR. Coincident with the start of CPR, the animals were randomized to receive ABO (n=15) or control (n=12). Meanwhile, normal saline was intravenously infused at a speed of 0.7 ml/kg/min in all animals.
Results:
During CPR, significantly greater coronary perfusion pressure, regional cerebral oxygen saturation and end-tidal CO
2
were observed in animals treated with ABO when compared with the control group (Table). Consequently, the rate of resuscitation success was significantly higher in the ABO group than in the control group (15/15 vs. 9/12,
p
= 0.040). Additionally, shorter duration of CPR (5.1±0.5 vs. 7.5±4.5 min,
p
= 0.054) and less number of shocks (1.1±0.3 vs. 2.0±1.8,
p
= 0.058) were required for establishing spontaneous circulation in the ABO group compared to the control group.
Conclusion:
The implementation of ABO during CPR significantly increased cardiac and cerebral perfusion and improved the outcomes of resuscitation in TCA following massive hemorrhage.
288 Endovascular Variable Aortic Control Improves Cardiac Performance When Compared to Resuscitative Endovascular Balloon Occlusion of the Aorta in a Swine Model of Hemorrhagic Shock
