PMID- 33502148
OWN - NLM
STAT- MEDLINE
DCOM- 20210415
LR  - 20230825
IS  - 2163-0763 (Electronic)
IS  - 2163-0755 (Linking)
VI  - 90
IP  - 2
DP  - 2021 Feb 1
TI  - Therapeutic cardiac arrest as an adjunct to resuscitative endovascular balloon 
      occlusion of the aorta: Bridging the gap from fatal hemorrhage to definitive 
      surgical control in swine.
PG  - 369-375
LID - 10.1097/TA.0000000000003024 [doi]
AB  - BACKGROUND: Uncontrolled hemorrhage is the leading cause of potentially 
      survivable combat casualty mortality, with 86.5% of cases resulting from 
      noncompressible torso hemorrhage. Resuscitative endovascular balloon occlusion of 
      the aorta (REBOA) is a minimally invasive technique used to stabilize patients 
      with noncompressible torso hemorrhage; however, its application can take an 
      average of 8 minutes to place. One therapeutic capable of bridging this gap is 
      adenosine-lidocaine-magnesium (ALM), which at high doses induces a reversible 
      cardioplegia. We hypothesize by using ALM as an adjunct to REBOA, the ALM-induced 
      cardiac arrest will temporarily halt exsanguination and reduce blood loss, 
      allowing for REBOA placement and control of bleeding. METHODS: Male Yorkshire 
      swine (60-80 kg) were randomly assigned to REBOA only or ALM-REBOA (n = 8/group). 
      At baseline, uncontrolled hemorrhage was induced via a 1.5-cm right femoral 
      arteriotomy, and hemorrhaged blood was quantified. One minute after injury (S1), 
      ALM was administered, and 7 minutes later (T0), zone 1 REBOA inflation occurred. 
      If cardiac arrest ensued, cardiac function either recovered spontaneously or 
      advanced life support was initiated. At T30, surgical hemostasis was obtained, 
      and REBOA was deflated. Animals were resuscitated until they were humanely 
      euthanized at T90. RESULTS: During field care phase, heart rate and end-tidal CO2 
      of the ALM-REBOA group were significantly lower than the REBOA only group. While 
      mean arterial pressure significantly decreased from baseline, no significant 
      differences between groups were observed throughout the field care phase. There 
      was no significant difference in survival between the two groups (ALM-REBOA = 89% 
      vs. REBOA only = 100%). Total blood loss was significantly decreased in the 
      ALM-REBOA group (REBOA only = 24.32 +/- 1.89 mL/kg vs. ALM-REBOA = 17.75 +/- 2.04 
      mL/kg, p = 0.0499). CONCLUSION: Adenosine-lidocaine-magnesium is a novel 
      therapeutic, which, when used with REBOA, can significantly decrease the amount 
      of blood loss at initial presentation, without compromising survival. This study 
      provides proof of concept for ALM and its ability to bridge the gap between 
      patient presentation and REBOA placement.
CI  - Copyright (c) 2020 Wolters Kluwer Health, Inc. All rights reserved.
FAU - Stigall, Kyle S
AU  - Stigall KS
AD  - From the Department of Surgery, San Antonio Military Medical Center (K.S.S., 
      E.N.H., M.M.T., J.J.G.); Department of Expeditionary and Trauma Medicine, Naval 
      Medical Research Unit San Antonio (L.E.N., C.G.M., P.J.H., D.R.B., M.S., M.M.T., 
      S.C., J.J.G.), JBSA-Fort Sam Houston; and Austin Shock Trauma (J.J.G.), St 
      David's South Austin Medical Center, Austin, Texas.
FAU - Neidert, Leslie E
AU  - Neidert LE
FAU - Morgan, Clifford G
AU  - Morgan CG
FAU - Hemond, Peter J
AU  - Hemond PJ
FAU - Brown, Dallas R
AU  - Brown DR
FAU - Salas, Mary
AU  - Salas M
FAU - Hathaway, Emily N
AU  - Hathaway EN
FAU - Tiller, Michael M
AU  - Tiller MM
FAU - Cardin, Sylvain
AU  - Cardin S
FAU - Glaser, Jacob J
AU  - Glaser JJ
LA  - eng
PT  - Journal Article
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PL  - United States
TA  - J Trauma Acute Care Surg
JT  - The journal of trauma and acute care surgery
JID - 101570622
RN  - 0 (Cardioplegic Solutions)
RN  - 0 (Cardiovascular Agents)
RN  - 0 (Pharmaceutical Solutions)
RN  - 98PI200987 (Lidocaine)
RN  - I38ZP9992A (Magnesium)
RN  - K72T3FS567 (Adenosine)
SB  - IM
MH  - Adenosine/*pharmacology
MH  - Animals
MH  - Aorta
MH  - Balloon Occlusion/*methods
MH  - Cardioplegic Solutions/*pharmacology
MH  - Cardiovascular Agents/*pharmacology
MH  - Disease Models, Animal
MH  - Endovascular Procedures/methods
MH  - Exsanguination/*therapy
MH  - Heart Arrest, Induced/*methods
MH  - Hemostasis, Surgical/methods
MH  - Lidocaine/*pharmacology
MH  - Magnesium/*pharmacology
MH  - Pharmaceutical Solutions
MH  - Preoperative Care/methods
MH  - Resuscitation/methods
MH  - Swine
EDAT- 2021/01/28 06:00
MHDA- 2021/04/16 06:00
CRDT- 2021/01/27 10:46
PHST- 2021/01/27 10:46 [entrez]
PHST- 2021/01/28 06:00 [pubmed]
PHST- 2021/04/16 06:00 [medline]
AID - 01586154-202102000-00022 [pii]
AID - 10.1097/TA.0000000000003024 [doi]
PST - ppublish
SO  - J Trauma Acute Care Surg. 2021 Feb 1;90(2):369-375. doi: 
      10.1097/TA.0000000000003024.