PMID- 31260423
OWN - NLM
STAT- MEDLINE
DCOM- 20200120
LR  - 20200120
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 87
IP  - 1
DP  - 2019 Jul
TI  - Preperitoneal balloon tamponade and resuscitative endovascular balloon occlusion 
      of the aorta: Alternatives to open packing for pelvic fracture-associated 
      hemorrhage.
PG  - 18-26
LID - 10.1097/TA.0000000000002266 [doi]
AB  - BACKGROUND: The objective of this study was to compare the efficacy of 
      preperitoneal balloon tamponade (PPB), resuscitative endovascular balloon 
      occlusion of the orta (REBOA), and open preperitoneal packing (OP) in a realistic 
      animal model of pelvic fracture-associated hemorrhage. METHODS: Thirty-nine swine 
      underwent creation of open-book pelvic fracture and iliac vascular injury. 
      Animals were randomized to no intervention (n = 7), OP (n = 10), PPB (n = 9), 
      zone 1 REBOA (n = 7), and zone 3 REBOA (n = 6) at a mean arterial pressure less 
      than 40 mm Hg from uncontrolled hemorrhage. Primary outcome was survival at 1 
      hour. Secondary outcomes included survival in the immediate 10 m following 
      intervention reversal, peak preperitoneal pressure (PP), blood loss, bleed rate, 
      and peak lactate. RESULTS: Prior to injury, no difference was measured between 
      groups for weight, hemodynamics, lactate, and hematocrit (all p = NS). The injury 
      was uniformly lethal without intervention, with survival time (mean) of 5 m, peak 
      PP of 14 mm Hg, blood loss of 960 g, bleed rate of 450 g/m, and peak lactate of 
      2.6 mmol/L. Survival time (m) was extended to 44 with OP, 60 with PPB, and 60 
      with REBOA (p < 0.01). Peak PP (mm Hg) was 19 with OP, 23 with PPB, 10 with zone 
      1 REBOA, and 6 with zone 3 REBOA (p < 0.05). Blood loss (g) was 850 with OP, 930 
      with PPB, 610 with zone 1 REBOA, and 370 with zone 3 REBOA (p < 0.01). Peak 
      lactate (mmol/L) was 3.3 with OP, 4.3 with PPB, 13.4 with zone 1 REBOA, and 5.3 
      with zone 3 REBOA (p < 0.01). Only 33% of zone 1 REBOA animals survived the 
      initial 10 m after balloon deflation, compared to 60% for OP, 67% for PPB, and 
      100% for zone 3 REBOA (p < 0.01). CONCLUSION: Preperitoneal balloon tamponade and 
      zone 3 REBOA are effective alternatives to OP in this animal model of lethal 
      pelvic fracture-associated hemorrhage. Zone 1 REBOA extends survival time but 
      with high mortality upon reversal.
FAU - Do, Woo S
AU  - Do WS
AD  - From the Departments of Surgery and Clinical Investigations (W.S.D., D.M.R., 
      R.R.S., J.B.W., M.R.B., K.K.S., G.E.B., S.R.H., M.J.E., M.J.M.), Madigan Army 
      Medical Center, Tacoma, Washington; and Trauma and Emergency Surgery Service 
      (M.J.M.), Legacy Emanuel Medical Center, Portland, Oregon.
FAU - Forte, Dominic M
AU  - Forte DM
FAU - Sheldon, Rowan R
AU  - Sheldon RR
FAU - Weiss, Jessica B
AU  - Weiss JB
FAU - Barron, Morgan R
AU  - Barron MR
FAU - Sokol, Kyle K
AU  - Sokol KK
FAU - Black, George E
AU  - Black GE
FAU - Hegge, Sara R
AU  - Hegge SR
FAU - Eckert, Matthew J
AU  - Eckert MJ
FAU - Martin, Matthew J
AU  - Martin MJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
SB  - IM
MH  - Animals
MH  - *Aorta
MH  - Balloon Occlusion/*methods
MH  - Disease Models, Animal
MH  - Fractures, Bone/*therapy
MH  - Hemorrhage/therapy
MH  - Male
MH  - Pelvic Bones/*injuries
MH  - Resuscitation/*methods
MH  - Shock, Hemorrhagic/*therapy
MH  - Swine
EDAT- 2019/07/02 06:00
MHDA- 2020/01/21 06:00
CRDT- 2019/07/02 06:00
PHST- 2019/07/02 06:00 [entrez]
PHST- 2019/07/02 06:00 [pubmed]
PHST- 2020/01/21 06:00 [medline]
AID - 01586154-201907000-00003 [pii]
AID - 10.1097/TA.0000000000002266 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2019 Jul;87(1):18-26. doi: 10.1097/TA.0000000000002266.