PMID- 31576422 OWN - NLM STAT- MEDLINE DCOM- 20210623 LR - 20240229 IS - 1863-9941 (Electronic) IS - 1863-9933 (Linking) VI - 46 IP - 6 DP - 2020 Dec TI - Resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhagic shock and blunt thoracic injury. PG - 1357-1366 LID - 10.1007/s00068-019-01185-3 [doi] AB - PURPOSE: While resuscitative endovascular balloon occlusion of the aorta (REBOA) is contraindicated in patients with aortic injuries, this technique may benefit poly-trauma patients with less extreme thoracic injuries. The purpose of this study was to characterize the effects of thoracic injury on hemodynamics during REBOA and the changes in pulmonary contusion over time in a swine model. METHODS: Twelve swine were anesthetized, instrumented, and randomized to receive either a thoracic injury with 5 impacts to the chest or no injury. All animals underwent controlled hemorrhage of 25% blood volume followed by 45 min of Zone 1 REBOA. Animals were then resuscitated with shed blood, observed during a critical care period, and euthanized after 6 h of total experimental time. RESULTS: There were no differences between the groups at baseline. The only difference after 6 h was a lower hemoglobin in the thoracic trauma group (8.4 +/- 0.8 versus 9.4 +/- 0.6 g/dL, P = 0.04). The average proximal mean arterial pressures were significantly lower in the thoracic trauma group during aortic occlusion [103 (98-108) versus 117 (115-124) mmHg, P = 0.04]. There were no differences between the pulmonary contusion before REBOA and at the end of the experiment in size (402 +/- 263 versus 356 +/- 291 mL, P = 0.782) or density (- 406 +/- 127 versus - 299 +/- 175 HFU, P = 0.256). CONCLUSIONS: Thoracic trauma blunted the proximal arterial pressure augmentation during REBOA but had minimal impacts on resuscitative outcomes. This initial study indicates that REBOA does not seem to exacerbate pulmonary contusion in swine, but blunt thoracic injuries may attenuate the expected rises in proximal blood pressure during REBOA. FAU - Beyer, Carl A AU - Beyer CA AUID- ORCID: 0000-0002-9785-8526 AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. cbeyer@ucdavis.edu. AD - Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA. cbeyer@ucdavis.edu. FAU - Hoareau, Guillaume L AU - Hoareau GL AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. FAU - Kashtan, Harris W AU - Kashtan HW AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. AD - Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA. FAU - Wishy, Andrew M AU - Wishy AM AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. AD - Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA. FAU - Caples, Connor AU - Caples C AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. AD - Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA. FAU - Spruce, Marguerite AU - Spruce M AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. AD - Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA. FAU - Grayson, John K AU - Grayson JK AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. FAU - Neff, Lucas P AU - Neff LP AD - Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. FAU - Williams, Timothy K AU - Williams TK AD - Department of Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, USA. FAU - Johnson, Michael A AU - Johnson MA AD - Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA, USA. AD - Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA. LA - eng GR - W81XWH-16-2-0043/Defense Health Agency/ PT - Journal Article DEP - 20191001 PL - Germany TA - Eur J Trauma Emerg Surg JT - European journal of trauma and emergency surgery : official publication of the European Trauma Society JID - 101313350 SB - IM MH - Animals MH - *Balloon Occlusion/methods MH - Disease Models, Animal MH - *Endovascular Procedures/methods MH - Hemodynamics MH - Resuscitation/methods MH - *Shock, Hemorrhagic/therapy MH - Swine MH - *Thoracic Injuries/therapy OTO - NOTNLM OT - Blunt thoracic trauma OT - Hemorrhagic shock OT - Poly-trauma OT - Pulmonary contusion OT - Resuscitative endovascular balloon occlusion of the aorta (REBOA) EDAT- 2019/10/03 06:00 MHDA- 2021/06/23 06:00 CRDT- 2019/10/03 06:00 PHST- 2019/03/25 00:00 [received] PHST- 2019/07/08 00:00 [accepted] PHST- 2019/10/03 06:00 [pubmed] PHST- 2021/06/23 06:00 [medline] PHST- 2019/10/03 06:00 [entrez] AID - 10.1007/s00068-019-01185-3 [pii] AID - 10.1007/s00068-019-01185-3 [doi] PST - ppublish SO - Eur J Trauma Emerg Surg. 2020 Dec;46(6):1357-1366. doi: 10.1007/s00068-019-01185-3. Epub 2019 Oct 1.