Finding the Right Balance: Partial REBOA in a Swine Model of Uncontrolled Vascular Injury

Jessie W. Ho, Zaiba Shafik Dawood, Jessica Nguyen, Dariel A. Diaz-Perez, Meredith E. Taylor, Kiril Chtraklin, Guang Jin, Baoling Liu, Rebecca A. Ober, Hasan B. Alam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: We have previously shown that partial REBOA (pREBOA) deployment in the thoracic aorta is safe for 2 to 4 hours, but it is unclear whether the distal blood flow after partial aortic occlusion would lead to ongoing hemorrhage. The objective of this study was to evaluate the hemostatic efficacy of pREBOA in a model of uncontrolled vascular injury. STUDY DESIGN: Female Yorkshire swine (n = 10, 40 to 45 kg) were anesthetized and instrumented. A through- and-through injury was created in the common iliac artery. The animals were randomly assigned to: (1) pREBOA-PRO deployment after 3 minutes and (2) control. Both groups were given normal saline resuscitation for hypotension. The pREBOA was adjusted to partial occlusion (distal mean arterial pressure of 30 mmHg), and then left without titration for 2 hours. Then, fresh frozen plasma was transfused and the vessel repaired. The balloon was deflated and the animals were monitored for 2 hours. In the critical care period, 2 L of normal saline was infused, norepinephrine was given for mean arterial pressure ≤55, and electrolytes and acidosis were corrected. Organs were examined for gross and histologic evidence of ischemic injuries. The primary endpoint was post-inflation blood loss. RESULTS: All the pREBOA animals survived until the end, whereas control animals had a mean survival time of 38.2 minutes (p < 0.05). The pREBOA group showed significantly less bleeding after balloon deployment (93.8 vs 1,980.0 mL, p < 0.05), and had appropriate lactate clearance, with minimal histologic distal organ ischemia. CONCLUSIONS: Partial aortic occlusion with the newly designed balloon can achieve the desired balance between effective hemorrhage control and adequate distal flow, without a need for ongoing balloon titration. (J Am Coll Surg 2024;238:32–40.

Original languageEnglish (US)
Pages (from-to)32-40
Number of pages9
JournalJournal of the American College of Surgeons
Volume238
Issue number1
DOIs
StatePublished - Jan 1 2024

Funding

This work was funded by the US Department of Defense (Contract: MT17008.034, Award: W81XWH-15-9-0001 to Dr Alam). The authors thank the Center for Comparative Medicine, in particular, Alicia McLuckie, DVM for her support. Support: This work was funded by the US Department of Defense (Contract: MT17008.034, Award: W81XWH-15-9-0001 to Dr Alam).

ASJC Scopus subject areas

  • General Medicine

Fingerprint

Dive into the research topics of 'Finding the Right Balance: Partial REBOA in a Swine Model of Uncontrolled Vascular Injury'. Together they form a unique fingerprint.

Cite this