Gastroesophageal resuscitative occlusion of the aorta: Physiologic tolerance in a swine model of hemorrhagic shock

Abstract

BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been shown to be effective for management of noncompressible torso hemorrhage. However, this technique requires arterial cannulation, which can be time-consuming and not amendable to placement in austere environments. We present a novel, less invasive aortic occlusion device and technique designated gastroesophageal resuscitative occlusion of the aorta (GROA). In this study, we aimed to characterize the physiological tolerance and hemodynamic effects of a prototype GROA device in a model of severe hemorrhagic shock and resuscitation and compare with REBOA. METHODS Swine (N = 47) were surgically instrumented for data collection. A 35% controlled arterial hemorrhage was followed by randomizing animals to 30-minute, 60-minute, or 90-minute interventions of GROA, REBOA, or control. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional 4 hours. RESULTS All animals except one GROA 90-minute application survived the duration of their intervention periods. Survival through resuscitation phase in GROA, REBOA, and control groups was similar in the 30-minute and 60-minute groups. The 90-minute occlusion groups exhibited deleterious effects upon device deactivation and reperfusion with two GROA animals surviving and no REBOA animals surviving. Mean (SD) arterial pressure in GROA and REBOA animals increased across all groups to 98 (31.50) mm Hg and 122 (24.79) mm Hg, respectively, following intervention. Lactate was elevated across all GROA and REBOA groups relative to controls during intervention but cleared by 4 hours in the 30-minute and 60-minute groups. Postmortem histological examination of the gastric mucosa revealed mild to moderate inflammation across all GROA groups. CONCLUSION In this study, the hemodynamic effects and physiological tolerance of GROA was similar to REBOA. The GROA device was capable of achieving high zone II full aortic occlusion and may be able to serve as an effective method of aortic impingement.

Gastroesophageal resuscitative occlusion of the aorta prolongs survival in a lethal liver laceration model

“…The hemodynamic effects of GROA and REBOA observed in this study were again similar to previous reports 14,22,23 . Initiation of either technology resulted in rapid and improved carotid arterial pressure and increased Smv o 2 , suggestive of redistributed blood flow and improvement of brain and cardiac perfusion and improved tissue oxygenation, despite hypovolemia.…”

“…For animals undergoing REBOA or GROA interventions, these devices were placed prior to hemorrhage. The REBOA catheter (ER-REBOA; Prytime Medical) was placed according to estimated external measurements to provide zone II occlusion with the balloon just inferior to the diaphragm as described previously 14 . The GROA device has been previously described 14 and is presented in Figure 1.…”

“…The REBOA catheter (ER-REBOA; Prytime Medical) was placed according to estimated external measurements to provide zone II occlusion with the balloon just inferior to the diaphragm as described previously 14 . The GROA device has been previously described 14 and is presented in Figure 1. It consists of a triple lumen gastroesophageal tube with an inflatable ellipsoid-shaped balloon at its tip.…”

“…We have shown in a previous investigation that when inflated and when external abdominal pressure is applied, it is capable of occluding the descending aorta between the posterior stomach and anterior thoracic vertebrae, therefore stopping blood flow distal of the occlusion. 14 Here, we aimed to determine if the GROA device is capable of stopping lethal abdominal hemorrhage and subsequently improve survival. We hypothesized that the GROA device would stop hemorrhage and increase survival in a lethal model of liver laceration, similar to REBOA, when compared with noninterventional controls.…”

Morphometric Analysis of the Aorto-Esophageal Relationship in Swine for Trans-Esophageal Aortic Blood Flow Occlusion

“…Transesophageal echocardiography takes advantage of this relationship to assess the heart and aorta. In addition, a new technique -gastroesophageal (GE) resuscitative occlusion of the aorta -has been shown to achieve full, temporary aortic occlusion through deployment of a device within the proximal stomach [8]. Trans-esophageal aortic blood flow occlusion (TEABO) is another emerging technology undergoing laboratory research, which offers a strategy for temporary hemorrhage control in the pre-hospital setting prior to definitive surgical control.…”