The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a hemorrhage control and resuscitative adjunct that has been demonstrated to improve central perfusion during hemorrhagic shock. The aim of this study was to characterize the systemic inflammatory response associated and cardiopulmonary sequelae with 30, 60, and 90 min of balloon occlusion and shock on the release of interleukin 6 (IL-6) and tumor necrosis factor alpha.


METHODS
Anesthetized female Yorkshire swine (Sus scrofa, weight 70-90 kg) underwent a 35% blood volume-controlled hemorrhage followed by thoracic aortic balloon occlusion of 30 (30-REBOA, n = 6), 60 (60-REBOA, n = 8), and 90 min (90-REBOA, n = 6). This was followed by resuscitation with whole blood and crystalloid over 6 h. Animals then underwent 48 h of critical care with sedation, fluid, and vasopressor support.


RESULTS
All animals were successfully induced into hemorrhagic shock without mortality. All groups responded to aortic occlusion with a rise in blood pressure above baseline values. IL-6, as measured (picogram per milliliter) at 8 h, was significantly elevated from baseline values in the 60-REBOA and 90-REBOA groups: 289 ± 258 versus 10 ± 5; P = 0.018 and 630 ± 348; P = 0.007, respectively. There was a trend toward greater vasopressor use (P = 0.183) and increased incidence of acute respiratory distress syndrome (P = 0.052) across the groups.


CONCLUSIONS
REBOA is a useful adjunct in supporting central perfusion during hemorrhagic shock; however, increasing occlusion time and shock results in a greater IL-6 release. Clinicians must anticipate inflammation-mediated organ failure in post-REBOA use patients.
The Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom; The United States Army Institute of Surgical Research, Fort Sam Houston, Texas; Academic Unit of Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom.
Jonathan J
JJ
Morrison
59th Medical Wing, Joint Base San Antonio, Lackland, Texas.
James D
JD
Ross
The United States Army Institute of Surgical Research, Fort Sam Houston, Texas.
Nickolay P
NP
Markov
The United States Army Institute of Surgical Research, Fort Sam Houston, Texas; 59th Medical Wing, Joint Base San Antonio, Lackland, Texas.
Daniel J
DJ
Scott
59th Medical Wing, Joint Base San Antonio, Lackland, Texas.
Jerry R
JR
Spencer
The United States Army Institute of Surgical Research, Fort Sam Houston, Texas; 59th Medical Wing, Joint Base San Antonio, Lackland, Texas; The Norman M. Rich Department of Surgery, the Uniformed Services University of the Health Sciences, Bethesda, Maryland. Electronic address: todd.e.rasmussen.mil@mail.mil.
Todd E
TE
Rasmussen
D000818:Animals; D001011:Aorta; D021721:Balloon Occlusion / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics; D007249:Inflammation / Q000209:etiology*; D015850:Interleukin-6 / Q000097:blood; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000276:immunology / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha
Hemorrhagic shock; Noncompressible torso hemorrhage; REBOA; Resuscitation; Resuscitative endovascular balloon occlusion of the aorta