Is Aortic Occlusion Advisable in the Management of Massive Hemorrhage? Experimental Study in Dogs

Mitteldorf, Cornelius; Poggetti, Renato Sérgio; Zanoto, Arnaldo; Branco, P D; Birolini, D; Tolosa, Erasmo Magalhães Castro de; Silva, Maurício Rocha e

doi:10.1097/00024382-199808000-00010

Cited by 9 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A few recent studies have explored the effect of REBOA on cerebral haemodynamic (CH) with and without brain injury [37][38][39][40][41][42]. They were unable to establish that using REBOA in animals in HS and with TBI worsened the brain injury, although ICP and pMAP rose signi cantly [20,38,42].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Haemodynamics and Intracranial Pressure during Haemorrhagic Shock and Resuscitation with Total Endovascular Balloon Occlusion of the Aorta in an Animal Model

Bader,

Brorsson,

Lofgren

et al. 2024

Preprint

View full text Add to dashboard Cite

Purpose To assess changes of cerebral haemodynamic and intracranial pressure (ICP) in animals, with or without elevated ICP, during controlled haemorrhagic shock and resuscitation with Total REBOA (tREBOA). Method In 22 anesthetized and normoventilated pigs, after placement of catheters for monitoring invasive proximal blood pressure (pMAP), ICP, and vital parameters, and 60 minutes stabilization phase, a controlled haemorrhagic shock (HS), was conducted. In 11 pigs (EICPG), an elevated ICP of 25–30 mmHg at the end HS was achieved by simulating an epidural mass. In 11 pigs (NICPG), the ICP was normal. tREBOA was then applied for 120 minutes. The changes of pMAP and ICP was followed and cerebral perfusion pressure (CPP) calculated. The integrity of the autoregulation was estimated using a calculated modified PRx index. Results After stabilization, hemodynamics and physiological parameters were similar and normal in both groups. At the end of the HS, ICP was 16 mmHg in NICPG vs 32 in EICPG (p = 0.0010). CPP was 30 mmHg in NICPG vs 6 mmHg in EICPG (p = 0.0254). After aorta occlusion CPP increased immediately in both groups reaching after 15 minutes up to104 mmHg in NICPG vs 126 mmHg in EICPG. Cerebrovascular reactivity seems to be altered during bleeding and occlusion phases in both groups with positive PRx. The alteration was more pronounced in EICPG, but reversible in both groups. Conclusion tREBOA is lifesaving by restoration the cerebral circulation defined as CPP in animals with HS with normal or elevated ICP. Despite the observation of short episodes of cerebral autoregulation impairment during the occlusion, mainly in EICPG, tREBOA seems to be an effective tool for improving cerebral perfusion in HS that extends the crucial early window sometimes known as the “golden hour” for resuscitation even after a traumatic brain injury.

show abstract

Section: Introductionmentioning

confidence: 99%

Cerebral Haemodynamics and Intracranial Pressure during Haemorrhagic Shock and Resuscitation with Total Endovascular Balloon Occlusion of the Aorta in an Animal Model

Bader,

Brorsson,

Lofgren

et al. 2024

Preprint

View full text Add to dashboard Cite

show abstract

“…The occlusion of the thoracic aorta is known to restore central aortic pressure in hemorrhagic shock [10,[14][15][16] and has been shown in an animal model of uncontrolled hemorrhage to increase survival in comparison with resuscitation using normal saline without hemorrhage control [8]. Deleterious effects of aortic occlusion and the magnitude of these effects are related to duration of occlusion [9,15,[17][18][19][20]. Although the outcome of cREBOA is the same as cross clamping of the aorta through a thoracotomy, the physiologic insult by the endovascular approach has been shown to be less than with the open method [7].…”

Section: Introductionmentioning

confidence: 99%

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

Dubick

Yang

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

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.

show abstract

“…ressecamento térmico e irradiação. (52,59,67,(71)(72)(73)(74)(75)(76) Os trabalhos que descrevem modelos experimentais de lesão vascular hemorrágica dividem-se em três categorias: os que realizam lesão do vaso sob visão direta (77) , aqueles que realizam lesão sem controle visual, e os que utilizam radioscopia (67) . Para vasos abdominais, a lesão vascular sob visão direta exige a realização de laparotomia.…”

Section: Discussionunclassified

“…Para a anestesia, escolhemos o pentobarbital porque é facilmente utilizado, apresenta um efeito uniforme e permite a manutenção de um nível profundo e constante de anestesia (75,76,78) . Entretanto, essa droga eleva a freqüência cardíaca, a pressão arterial e a resistência periférica (75,76,79) . (32,35,(68)(69)(70) MITTELDORF et al (1998) (75) utilizaram, em estudo experimental, a oclusão intermitente da aorta com balão, ao nível da aorta torácica, como medida de controle de sangramento em choque hemorrágico grave e obtiveram complicações com paraplegia (23%) e óbito (16%).…”

Section: Discussionunclassified

See 1 more Smart Citation

Lesão letal transfixante de veia cava-justa-hepática e tratamento com endoprótese revestida: um novo modelo experimental

Porta¹

View full text Add to dashboard Cite

Is Aortic Occlusion Advisable in the Management of Massive Hemorrhage? Experimental Study in Dogs

Cited by 9 publications

References 0 publications

Cerebral Haemodynamics and Intracranial Pressure during Haemorrhagic Shock and Resuscitation with Total Endovascular Balloon Occlusion of the Aorta in an Animal Model

Cerebral Haemodynamics and Intracranial Pressure during Haemorrhagic Shock and Resuscitation with Total Endovascular Balloon Occlusion of the Aorta in an Animal Model

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

Lesão letal transfixante de veia cava-justa-hepática e tratamento com endoprótese revestida: um novo modelo experimental

Contact Info

Product

Resources

About