Aortic Branch Vessel Flow During Resuscitative Endovascular Balloon Occlusion of the Aorta

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Abstract

Background

REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is a torso hemorrhage control adjunct. Aortic branch vessel flow (BVF) during REBOA is poorly characterized and has implications for ischemia-reperfusion (I-R) injury. The aim of this study is to quantify branch vessel flow in hypovolemic shock with and without REBOA.

Methods

Female swine (79-90kg) underwent anesthesia, 40% controlled hemorrhage and sonographic flow monitoring of the carotid, hepatic, superior mesenteric, renal and femoral arteries. Animals were randomized to REBOA (n=5) or no-REBOA (n=5) for 4 hours, followed by full resuscitation and balloon deflation for 1-hour.

Results

All animals were successfully induced into hemorrhagic shock with a mean decrease of flow in all vessels of 50% from baseline (p<0.001). Deployment of REBOA resulted in a 200-400% increase in carotid flow, but near complete abolition of BVF distal to the balloon (Figure). The no-REBOA group saw recovery of BVF to 100% of baseline in all measured vessels, except the hepatic at 50-75%. 2-way ANOVA confirmed a significant difference between the groups throughout the protocol (p<0.001). During resuscitation, the REBOA group saw BVF restore to between 25-50%, but never achieving baseline values. The lactate at 4 hours was significantly higher in the REBOA vs. no-REBOA group (17.2±0.1 vs. 4.9±1.4; p<0.001).

Conclusions

REBOA not only abolishing BVF during occlusion, but appears to have a post-REBOA effect, reducing visceral perfusion. This may be a source of REBOA associated I-R injury and warrants further investigation in order to mitigate this effect.

Level of Evidence

Level 3

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