title: Aortic balloon occlusion is effective in controlling pelvic hemorrhage.
abstract: BACKGROUND
  The objective of this study was to evaluate the efficacy of resuscitative endovascular aortic balloon occlusion (REBOA) of the distal aorta in a porcine model of pelvic hemorrhage.
  
  
  METHODS
  Swine were entered into three phases of study: injury (iliac artery), hemorrhage (45 s), and intervention (180 min). Three groups were studied: no intervention (NI, n = 7), a kaolin-impregnated gauze (Combat Gauze) (CG, n = 7), or REBOA (n = 7). The protocol was repeated with a dilutional coagulopathy (CG-C, n = 7, and REBOA-C, n = 7). Measures of physiology, rates of hemorrhage, and mortality were recorded.
  
  
  RESULTS
  Rate of hemorrhage was greatest in the NI group, followed by the REBOA and CG groups (822 ± 415 mL/min versus 11 ± 13 and 0.2 ± 0.4 mL/min respectively; P < 0.001). MAP following intervention (at 15 min) was the same in the CG and REBOA groups and higher than in the NI group (70 ± 4 and 70 ± 11 mm Hg versus 5 ± 13 mm Hg respectively; P < 0.001). There was 100% mortality in the NI group, with no deaths in the CG or REBOA group. In the setting of coagulopathy, the rate of bleeding was higher in the CG-C versus the REBOA-C group (229 ± 295 mL/min versus 20 ± 7 mL/min, P = 0.085). MAP following intervention (15 min) was higher in the REBOA-C than the CG-C group (71 ± 12 mm Hg versus 28 ± 31 mm Hg; P = 0.005). There were 5 deaths (71.4%) in the CG-C group, but none in the REBOA-C group (P = 0.010).
  
  
  CONCLUSIONS
  Balloon occlusion of the aorta is an effective method to control pelvic arterial hemorrhage. This technique should be further developed as an adjunct to manage noncompressible pelvic hemorrhage.
authors.affiliation: 59th Clinical Research Division, Lackland Air Force Base, San Antonio, Texas, USA.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Percival
authors.forename: Nickolay P
authors.initials: NP
authors.lastname: Markov
authors.forename: Carole
authors.initials: C
authors.lastname: Villamaria
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.forename: Kaylyn A
authors.initials: KA
authors.lastname: Saches
authors.forename: Jerry R
authors.initials: JR
authors.lastname: Spencer
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
mesh_terms: D000818:Animals; D001012:Aorta, Abdominal / Q000293:injuries*; D021721:Balloon Occlusion; D058734:Exsanguination / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D007869:Leg Injuries / Q000150:complications; D013552:Swine