Military medicine · 2025
Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Versus Intermittent Resuscitative Endovascular Balloon Occlusion of the Aorta in Noncompressible Torso Hemorrhage With Concomitant Traumatic Brain Injury.
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Sanin Gloria D, Wood Elizabeth C, Gomez Micaela K, Cambronero Gabriel E, Lane Magan R, Patterson James W, Laingen Bonnie E, Azar Elizabeth A, Reid Garrett R, Renaldo Antonio C, Rahbar Elaheh, Johnson M Austin, Neff Lucas P, Williams Timothy K
Аннотация
INTRODUCTION: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) temporizes noncompressible torso hemorrhage (NCTH) and provides hemodynamic support, yet is limited by ischemic effects. Intermittent REBOA (iREBOA) and partial REBOA (pREBOA) strategies aim to mitigate these effects. iREBOA alternates between distal flow restoration and full aortic occlusion. pREBOA provides hemodynamic support with attenuated distal flow by dynamically adjusting balloon volume. Hemodynamic profiles differ between these strategies, with an uncertain impact on concomitant injuries like traumatic brain injury (TBI). We hypothesized that pREBOA would demonstrate more consistent cerebral hemodynamics in a porcine model of hemorrhage and TBI.
MATERIALS AND METHODS: Sixteen swine underwent standardized TBI, via cortical impactor, and liver transection, followed by 10 minutes of complete REBOA. Swine were then randomized to 80 minutes of automated iREBOA or pREBOA support. Following damage control surgery and whole blood transfusion, 90 minutes of automated closed-loop critical care was implemented. Hemodynamic parameters and ischemia-related laboratory values were recorded. Hypotension was defined as mean arterial pressure (MAP) < 60 mmHg, and hypertension as MAP > 70 mmHg.
RESULTS: Carotid flow fluctuated less in pREBOA vs iREBOA at time intervals 0-10 minutes (P = .038), 10-20 minutes (P = .036), 20-30 minutes (P = .001), and 40-50 minutes (P = .04). Cerebral perfusion pressure (CPP) varied more in iREBOA than pREBOA at 20-30 minutes and 30-40 minutes (P = .0007 and 0.048). There were no statistically significant differences in time spent in hypotension and hypertension for iREBOA and pREBOA (45.26% vs 17.22%, P = .27; 38.31% vs 49.19%, P = .56).
CONCLUSIONS: Partial REBOA with an automated system demonstrated more consistent CPP and carotid flow while maintaining proximal MAP. Dynamic control systems for NCTH are possible, and automation of pREBOA may balance competing risks of distal ischemia and proximal homeostasis in multi-injured trauma patients with TBI.
MATERIALS AND METHODS: Sixteen swine underwent standardized TBI, via cortical impactor, and liver transection, followed by 10 minutes of complete REBOA. Swine were then randomized to 80 minutes of automated iREBOA or pREBOA support. Following damage control surgery and whole blood transfusion, 90 minutes of automated closed-loop critical care was implemented. Hemodynamic parameters and ischemia-related laboratory values were recorded. Hypotension was defined as mean arterial pressure (MAP) < 60 mmHg, and hypertension as MAP > 70 mmHg.
RESULTS: Carotid flow fluctuated less in pREBOA vs iREBOA at time intervals 0-10 minutes (P = .038), 10-20 minutes (P = .036), 20-30 minutes (P = .001), and 40-50 minutes (P = .04). Cerebral perfusion pressure (CPP) varied more in iREBOA than pREBOA at 20-30 minutes and 30-40 minutes (P = .0007 and 0.048). There were no statistically significant differences in time spent in hypotension and hypertension for iREBOA and pREBOA (45.26% vs 17.22%, P = .27; 38.31% vs 49.19%, P = .56).
CONCLUSIONS: Partial REBOA with an automated system demonstrated more consistent CPP and carotid flow while maintaining proximal MAP. Dynamic control systems for NCTH are possible, and automation of pREBOA may balance competing risks of distal ischemia and proximal homeostasis in multi-injured trauma patients with TBI.