title: Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock.
abstract: Complete resuscitative endovascular balloon occlusion of the aorta (C-REBOA) increases proximal mean arterial pressure (MAP) at the cost of distal organ ischemia, limiting the duration of intervention. We hypothesized that partial aortic occlusion (P-REBOA) would maintain a more physiologic proximal MAP and reduce distal tissue ischemia. We investigated the hemodynamic and physiologic effects of P-REBOA vs C-REBOA.
  
  
  
  Fifteen swine were anesthetized, instrumented, splenectomized, and subjected to rapid 25% blood volume loss. They were randomized to C-REBOA, P-REBOA, or no intervention (controls). Partial REBOA was created by partially inflating an aortic balloon catheter to generate a 50% blood pressure gradient across the balloon. Hemodynamics were recorded and serum makers of ischemia and inflammation were measured. After 90 minutes of treatment, balloons were deflated to evaluate the immediate effects of reperfusion. End organs were histologically examined.
  
  
  
  Complete REBOA produced supraphysiologic increases in proximal MAP after hemorrhage compared with more modest augmentation in the P-REBOA group (p < 0.01), with both groups significantly greater than controls (p < 0.01). Less rebound hypotension after balloon deflation was seen in the P-REBOA compared with C-REBOA groups. Complete REBOA resulted in higher serum lactate than both P-REBOA and controls (p < 0.01). Histology revealed early necrosis and disruption of duodenal mucosa in all C-REBOA animals, but none in P-REBOA animals.
  
  
  
  In a porcine hemorrhagic shock model, P-REBOA resulted in more physiologically tolerable hemodynamic and ischemic changes compared with C-REBOA. Additional work is needed to determine whether the benefits associated with P-REBOA can both extend the duration of intervention and increase survival.
authors.affiliation: Department of Surgery, UC Davis Medical Center, Sacramento, CA; Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Russo
authors.affiliation: Department of Surgery, UC Davis Medical Center, Sacramento, CA; Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Department of General Surgery, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Lucas P
authors.initials: LP
authors.lastname: Neff
authors.affiliation: Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Department of Vascular and Endovascular Surgery, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Lamb
authors.affiliation: Department of General Surgery, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Cannon
authors.affiliation: Department of Surgery, UC Davis Medical Center, Sacramento, CA.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.affiliation: Department of Pathology, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA.
authors.forename: Nathan F
authors.initials: NF
authors.lastname: Clement
authors.affiliation: Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA.
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Grayson
authors.affiliation: Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA; Department of Vascular and Endovascular Surgery, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA. Electronic address: timothy.williams.72@us.af.mil.
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Williams
mesh_terms: D000818:Animals; D001011:Aorta; D021721:Balloon Occlusion / Q000379:methods*; D057510:Endovascular Procedures / Q000295:instrumentation / Q000379:methods*; D005260:Female; D008297:Male; D011897:Random Allocation; D012151:Resuscitation / Q000295:instrumentation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy*; D034421:Sus scrofa; D016896:Treatment Outcome