Next-Generation REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) Device Precisely Achieves Targeted Regional Optimization in a Porcine Model of Hemorrhagic Shock

Polcz, Jeanette E.; Ronaldi, Alley E.; Madurska, Marta J; Bedőcs, Péter; Leung, Lai Yee; Burmeister, David M.; White, Paul W.; Rasmussen, Todd E.; White, Joseph

doi:10.1016/j.jss.2022.06.007

Cited by 12 publications

(19 citation statements)

References 24 publications

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“…Of note, there is conflicting data regarding the correlation of distal MAPs to distal flow rates for reliable balloon titrations in the field 25,27 . However, in this study the balloon was not titrated once the partial occlusion was achieved.…”

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

“…This balloon has also been used in a swine model by the White et al 24,25 group to optimize targeted distal perfusion using arterial flow rates of 300 mL·min −1 to define partial occlusion. These studies have highlighted the technical feasibility of the pREBOA-PRO, and importantly showed a linear correlation between the distal arterial flow rate with the distal MAP 25 . While the distal arterial flow rate provides an objective measure for true flow beyond the balloon, it is not a value that can be readily and directly obtained in a trauma patient.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies 10 and pilot experiments have demonstrated that a D-SBP of 10 mm Hg to 12 mm Hg was consistent with a complete occlusion. We then opted for a higher D-SBP to define partial occlusion yet lower than MAP of 30 mm Hg that allowed for survival in an uncontrolled hemorrhage model 25 . At this time, there is no specific MAP that has been identified as the “optimal” distal MAP in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Prolonging the zone 1 aortic occlusion time to 4 hours using a partial resuscitative endovascular balloon in a swine model

Jin

Nguyen

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND The clinical usage of the resuscitative endovascular balloon occlusion of the aorta (REBOA) is limited by distal ischemia resulting from complete aortic occlusion. We hypothesized that animals would physiologically tolerate the prolonged partial occlusion using the novel partially occluding REBOA (pREBOA) with survivable downstream injuries. METHODS This study used the pREBOA-PRO catheter in a previously established swine model. Female Yorkshire swine (n = 10) underwent a volume-controlled hemorrhage (40% estimated blood). After 1 hour of shock (mean arterial pressure, 28–32 mm Hg), animals were randomized to partial occlusion for either 2 hours or 4 hours. The pREBOA was inflated in zone 1 to achieve partial occlusion defined as a distal systolic blood pressure (SBP) of 20 ± 2 mm Hg. The balloon was deflated at the end of the occlusion period, and animals were resuscitated for 2 hours. Tissues were examined for gross and histologic injury. The primary endpoint was histologic organ injury, and secondary end points were hemodynamic variables and degree of distal organ ischemia. RESULTS All animals survived to the endpoint. Both groups had similar proximal and distal SBP at baseline, with a divergence of pressures ranging from 55 mm Hg to 90 mm Hg on inflation. The lactate levels increased throughout the occlusion and decreased approximately 40% during the observation period. More animals required norepinephrine and fluid in the 4-hour group compared with the 2-hour group. There was no gross small bowel ischemia noted in the 2-hour animals. The 4-hour group had surgically resectable patchy short segment ischemia. Neither group showed nonsurvivable organ ischemia on pathology or laboratory values. CONCLUSION This is the first study showing that the zone 1 aorta can be occluded for over 4 hours using a new pREBOA device without need for balloon titration. In conclusion, simple changes in balloon design offer reliable partial aortic occlusion, with potentially survivable and surgically manageable downstream injuries.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prolonging the zone 1 aortic occlusion time to 4 hours using a partial resuscitative endovascular balloon in a swine model

Jin

Nguyen

et al. 2023

J Trauma Acute Care Surg

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“…However, these guidelines are based on complete aortic occlusion. pREBOA allows for partial occlusion and thus a variable degree of distal blood flow [7][8][9]. A flow rate of 0.5 L/min has been shown to be effective at preventing ischemia while minimizing hemorrhage in swine [10].…”

Section: Discussionmentioning

confidence: 99%

Prolonged Partial REBOA: A Practice Paradigm for Managing Hemorrhage from Abdominal Gunshot Wounds

Zebley¹,

Halpern²,

Matecki³

et al. 2023

JEVTM

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a valuable tool for management of life-threateningtruncal hemorrhage. However, prolonged use of REBOA is limited by the ischemia that it causes distalto the occlusion. Partial REBOA (pREBOA) is a developing technique to inflate the balloon partially to allow for avariable degree of distal blood flow and mitigate some of the complications of prolonged occlusion of the aortawhile also ameliorating ongoing blood loss. We describe a case of a patient who presented with a gunshot woundto the right upper quadrant of the abdomen with significant liver, kidney, and colon injuries. The patient was successfullytreated with pREBOA for 20 hours without ischemic sequalae. This is the longest reported use of prolongedpREBOA and suggests that this technique may offer a means for hemorrhage control in the pre-/intra- andpostoperative settings..

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Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Limits Ischemia-Reperfusion Injury After Simulated Aeromedical Evacuation

Singer

Wallen

Youngs

et al. 2023

Journal of Surgical Research

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Next-Generation REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) Device Precisely Achieves Targeted Regional Optimization in a Porcine Model of Hemorrhagic Shock

Cited by 12 publications

References 24 publications

Prolonging the zone 1 aortic occlusion time to 4 hours using a partial resuscitative endovascular balloon in a swine model

Prolonging the zone 1 aortic occlusion time to 4 hours using a partial resuscitative endovascular balloon in a swine model

Prolonged Partial REBOA: A Practice Paradigm for Managing Hemorrhage from Abdominal Gunshot Wounds

Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Limits Ischemia-Reperfusion Injury After Simulated Aeromedical Evacuation

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