scholarly journals Automated Partial Versus Complete Resuscitative Endovascular Balloon Occlusion of the Aorta for the Management of Hemorrhagic Shock in a Pig Model of Polytrauma: a Randomized Controlled Pilot Study

2020 ◽  
Vol 185 (11-12) ◽  
pp. e1923-e1930
Author(s):  
Guillaume L Hoareau ◽  
Carl A Beyer ◽  
Connor A Caples ◽  
Marguerite W Spruce ◽  
J Kevin Grayson ◽  
...  
Keyword(s):  
Lactate Concentration ◽  
Balloon Occlusion ◽  
Control Group ◽  
Swine Model ◽  
Large Animal ◽  
Shed Blood ◽  
Potential Benefits ◽  
Plasma Lactate Concentration ◽  
Trauma Model ◽  
Endovascular Balloon Occlusion

Abstract Introduction Endovascular variable aortic control (EVAC) is an automated partial resuscitative endovascular balloon occlusion of the aorta (REBOA) platform designed to mitigate the deleterious effects of complete REBOA. Long-term experiments are needed to assess potential benefits. The feasibility of a 24-hour experiment in a complex large animal trauma model remains unknown. Materials and methods Anesthetized swine were subjected to controlled hemorrhage, blunt thoracic trauma, and tibial fractures. Animals were then randomized (N = 3/group) to control (No balloon support), 90 minutes of complete supraceliac REBOA, or 10 minutes of supraceliac REBOA followed by 80 minutes of EVAC. One hundred ten minutes after injury, animals were resuscitated with shed blood, the REBOA catheter was removed. Automated critical care under general anesthesia was maintained for 24 hours. Results Animals in the control and EVAC groups survived to the end of the experiment. Animals in the REBOA group survived for 120, 130, and 660 minutes, respectively. Animals in the EVAC group displayed similar mean arterial pressure and plasma lactate concentration as the control group by the end of the experiment. Histologic analysis suggested myocardial injury in the REBOA group when compared with controls. Conclusions This study demonstrates the feasibility of intermediate-term experiments in a complex swine model of polytrauma with 90 minutes of REBOA. EVAC may be associated with improved survival at 24 hours when compared with complete REBOA. EVAC resulted in normalized physiology after 24 hours, suggesting that prolonged partial occlusion is possible. Longer studies evaluating partial REBOA strategies are needed.

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

2021 ◽  
Author(s):  
Yuqing Huang ◽  
Xuexia Shan ◽  
Shengzheng Wu ◽  
Xianghui Chen ◽  
Xingxi Lin ◽  
...  
Keyword(s):  
Iliac Artery ◽  
Intervention Group ◽  
Balloon Occlusion ◽  
Maximum Depth ◽  
Control Group ◽  
Swine Model ◽  
Total Blood ◽  
Portable Ultrasound ◽  
The Right ◽  
Endovascular Balloon Occlusion

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.

Stepwise Reperfusion After Zone 1 REBOA: Is Repositioning to Zone 3 a Useful Maneuver?

2018 ◽  
Vol 2 (3) ◽  
Author(s):  
Emily M Tibbits ◽  
Guillaume L Hoareau ◽  
Meryl A Simon ◽  
Anders J Davidson ◽  
Erik S DeSoucy ◽  
...  
Keyword(s):  
Critical Care ◽  
Functional Outcomes ◽  
Lactate Concentration ◽  
Hemodynamic Instability ◽  
Balloon Occlusion ◽  
Shed Blood ◽  
Hemodynamic Support ◽  
Support Strategies ◽  
Peak Lactate ◽  
Endovascular Balloon Occlusion

Objectives:  One limitation of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is hemodynamic instability upon balloon deflation due to distal hyperemia and washout of ischemic metabolites.  We sought to determine whether stepwise reperfusion after supraceliac (Zone-1) REBOA by transitioning to infrarenal (Zone-3) occlusion would mitigate the physiologic consequences of balloon deflation and decrease hemodynamic instability. Methods:  Twelve anesthetized swine underwent controlled hemorrhage of 25% blood volume, 45 minutes of Zone-1 REBOA, then resuscitation with shed blood.  Standardized critical care began with deflation of the Zone-1 balloon in all animals, and continued for six hours. Half of the animals were randomly assigned to Zone-3 REBOA for an additional 45 minutes following Zone-1 balloon deflation. Results: There were no differences in physiology at baseline, during the initial 30 minutes of hypotension, or during the 45 minutes of Zone-1 occlusion.  After Zone-1 balloon deflation, there was no difference in proximal mean arterial pressure (pMAP) with or without Zone-3 occlusion, or percentage of critical care time spent within the target pMAP range between 65 and 75 mm Hg.  There were also no significant differences in peak lactate concentration or resuscitation requirements. Conclusions:  In an animal model of hemorrhagic shock and Zone-1 REBOA, subsequent Zone-3 aortic occlusion did not add significant ischemic burden, but it also did not provide significant hemodynamic support.  The effect of this strategy on functional outcomes warrants further study.  Continued investigation is necessary to determine optimal resuscitative support strategies during reperfusion following Zone-1 REBOA. 

scholarly journals Effects of Extended Lower Extremity Cooling Following Zone 3 REBOA in a Porcine Hemorrhage Model

2020 ◽  
Vol 185 (Supplement_1) ◽  
pp. 42-49 ◽  
Author(s):  
Harris W Kashtan ◽  
Meryl A Simon ◽  
Carl A Beyer ◽  
Andrew Wishy ◽  
Guillaume L Hoareau ◽  
...  
Keyword(s):  
Balloon Occlusion ◽  
Total Blood ◽  
Ischemic Time ◽  
Shed Blood ◽  
External Cooling ◽  
Physiologic Parameters ◽  
Hypothermia Group ◽  
Ischemic Muscle ◽  
Endovascular Balloon Occlusion ◽  
Serum Myoglobin

Abstract Introduction External cooling of ischemic limbs has been shown to have a significant protective benefit for durations up to 4 hours. Materials and Methods It was hypothesized that this benefit could be extended to 8 hours. Six swine were anesthetized and instrumented, then underwent a 25% total blood volume hemorrhage. Animals were randomized to hypothermia or normothermia followed by 8 hours of Zone 3 resuscitative endovascular balloon occlusion of the aorta, then resuscitation with shed blood, warming, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Results There were no significant differences between groups at baseline. There were no significant differences between creatine kinase in the hypothermia group when compared to the normothermia group (median [IQR] = 15,206 U/mL [12,476−19,987] vs 23,027 U/mL [18,745−26,843]); P = 0.13) at the end of the study. Similarly, serum myoglobin was also not significantly different in the hypothermia group after 8 hours (7,345 ng/mL [5,082−10,732] vs 5,126 ng/mL [4,720−5,298]; P = 0.28). No histologic differences were observed in hind limb skeletal muscle. Conclusion While external cooling during prolonged Zone 3 resuscitative endovascular balloon occlusion of the aorta appears to decrease ischemic muscle injury, this benefit appears to be time dependent. As the ischemic time approaches 8 hours, the benefit from hypothermia decreases.

Functional Outcome after Resuscitative Endovascular Balloon Occlusion of the Aorta of the Proximal and Distal Thoracic Aorta in a Swine Model of Controlled Hemorrhage

2015 ◽  
Vol 29 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Kira N. Long ◽  
Robert Houston ◽  
J. Devin B. Watson ◽  
Jonathan J. Morrison ◽  
Todd E. Rasmussen ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Thoracic Aorta ◽  
Balloon Occlusion ◽  
Swine Model ◽  
Endovascular Balloon Occlusion

Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury

2019 ◽  
Vol 46 (6) ◽  
pp. 1357-1366 ◽  
Author(s):  
Carl A. Beyer ◽  
Guillaume L. Hoareau ◽  
Harris W. Kashtan ◽  
Andrew M. Wishy ◽  
Connor Caples ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Balloon Occlusion ◽  
Thoracic Injury ◽  
Swine Model ◽  
Endovascular Balloon Occlusion

scholarly journals Distal organ inflammation and injury after resuscitative endovascular balloon occlusion of the aorta in a porcine model of severe hemorrhagic shock

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242450
Author(s):  
Yansong Li ◽  
Michael A. Dubick ◽  
Zhangsheng Yang ◽  
Johnny L. Barr ◽  
Brandon J. Gremmer ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Positive Control ◽  
Balloon Occlusion ◽  
Organ Injury ◽  
Trauma Patients ◽  
Total Blood ◽  
Shed Blood ◽  
Endovascular Balloon Occlusion

Background and objective Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine. Methods Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed. Results Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1β in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05). Conclusion 30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.

Abstract 358: Aortic Balloon Occlusion Augments the Efficacy of External Cardiopulmonary Resuscitation After Traumatic Cardiac Arrest in Swine

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Jiefeng Xu ◽  
Peng Shen ◽  
Senlin Xia ◽  
Yuzhi Gao ◽  
Shaoyun Liu ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Cerebral Perfusion ◽  
Coronary Perfusion Pressure ◽  
Balloon Occlusion ◽  
Control Group ◽  
Swine Model ◽  
Coronary Perfusion ◽  
Traumatic Cardiac Arrest ◽  
Aortic Balloon Occlusion

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.

Abstract 113: SUMO1 Gene Transfer Rescues Cardiac Function in a Large Animal Model of Heart Failure

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Lisa M Tilemann ◽  
Kiyotake Ishikawa ◽  
Changwon Kho ◽  
Ahyoung Lee ◽  
Jaime Aguero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gene Transfer ◽  
Cardiac Function ◽  
Therapeutic Potential ◽  
Critical Role ◽  
Balloon Occlusion ◽  
Large Animal Model ◽  
Swine Model ◽  
Large Animal ◽  
Cardiac Sarcoplasmic Reticulum

Recently, small ubiquitin-related modifier 1 (SUMO1) was found to enhance the activity and stability of the cardiac sarcoplasmic reticulum Ca2+ ATPase, SERCA2a. In both, human and rodent models of heart failure (HF), the total amount of myocardial SUMO1 is decreased and its knock down results in severe HF. Adeno-associated vector (AAV) mediated SUMO1 gene transfer significantly improves cardiac function in murine models of HF. As a critical step towards clinical translation, we evaluated the effects of SUMO1 gene transfer in a swine model of ischemic heart failure. One month after balloon occlusion of the proximal LAD, 21 animals were randomized to receive either AAV1.SUMO1 at two doses, AAV1.SERCA2a, AAV1.SUMO1+AAV1.SERCA2a, or saline via antegrade coronary infusion. In addition, three pigs served as controls and underwent sham procedures. The ejection fraction and the maximum dP/dt significantly increased after gene transfer of SUMO1 at both doses, SERCA2a and the combination of SUMO1 and SERCA2a (p=0.034, p=0.028) compared to saline infusion. The increase in maximum dP/dt was most pronounced in the group that received both SUMO1 and SERCA2a. Furthermore, the increase in end-systolic and end-diastolic volumes was normalized in the treatment groups, while they further deteriorated in the saline group (p=0.001, p=0.022). SUMO1 and SERCA2a gene transfer significantly improved cardiac function and concomitant gene delivery of SUMO1 and SERCA2a had a synergistic effect on improving these parameters in the HF animals. These results strongly support the critical role of SUMO1 for SERCA2a function and underline the therapeutic potential in heart failure patients.

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