PMID- 36749658 OWN - NLM STAT- MEDLINE DCOM- 20230428 LR - 20240502 IS - 2163-0763 (Electronic) IS - 2163-0755 (Print) IS - 2163-0755 (Linking) VI - 94 IP - 5 DP - 2023 May 1 TI - REBOA for the Treatment of Blast Polytrauma: Zone 3 Provides Cerebral Perfusion, Attenuates Organ Dysfunction and Reperfusion Coagulopathy Compared to Zone 1 in a Swine Model. PG - 718-724 LID - 10.1097/TA.0000000000003894 [doi] AB - BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a lifesaving therapy for hemorrhagic shock following pelvic/lower extremity injuries in military settings. However, Zone 1 aortic occlusion (AO; above the celiac artery), while providing brain/cardiac perfusion, may induce/worsen visceral ischemia and organ dysfunction. In contrast, AO Zone 3 (below the renal arteries) provides abdominal perfusion potentially minimizing ischemia/reperfusion injury. We hypothesized that, compared with AO Zone 1, AO Zone 3 provides neuro/cardioprotection while minimizing visceral ischemia and reperfusion coagulopathy after severe traumatic hemorrhage due to pelvic/lower extremity injuries. METHODS: Fifty-kilogram male Yorkshire swine underwent a blast polytrauma injury followed by a resuscitation protocol with randomization to no AO (No AO, n = 6) or AO with REBOA at Zone 1 (AO Zone 1; n = 6) or Zone 3 (AO Zone 3; n = 4). Vital signs and intracranial pressure (ICP) were monitored for 240 minutes. Citrate native and tissue plasminogen activator challenge thrombelastography, prothrombin time, creatinine, lipase, total bilirubin, troponin, and enzyme-linked immunosorbent assays protein levels were measured at set intervals. RESULTS: Both AO groups had significant increases in mean arterial pressure during aortic occlusion. All three groups had significant increases in ICP, but final ICP in the No AO group (26 +/- 5.8 mm Hg) was significantly elevated compared with AO Zone 1 (17 +/- 5.2 mm Hg) and AO Zone 3 (16 +/- 4.2 mm Hg) ( p < 0.01). The final mean troponin in the No AO group (4.10 +/- 5.67 ng/mL) was significantly higher than baseline (0.03 +/- 0.02 ng/mL, p < 0.05), while the two AO groups had no significant changes ( p > 0.05). AO Zone 1 was the only group associated with hyperfibrinolysis ( p < 0.05) and significantly increased prothrombin time ( p < 0.05). Only AO Zone 1 group had significantly higher markers of organ damage. CONCLUSION: Compared with AO Zone 1, AO Zone 3 provided similar neuro/cardioprotection but with less organ dysfunction and coagulopathy. This study suggests that Zone 3 REBOA may be preferable over Zone 1 for treating military relevant blast polytrauma with minimal intra-abdominal and chest trauma, but further clinical investigation is warranted. CI - Copyright (c) 2023 Wolters Kluwer Health, Inc. All rights reserved. FAU - Cralley, Alexis L AU - Cralley AL AD - From the Department of Surgery (A.L.C., E.E.M., A.S., T.R.S., M.D., M.F., A.G., M.J.C., C.C.S.), School of Medicine, University of Colorado; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), Denver; Department of Health Systems, Management and Policy (A.S.), School of Public Health, University of Colorado Denver, Aurora, Colorado; Faculdade Israelita de Ciencias da Saude Albert Einstein (P.H.C.), Hospital Israelita Albert Einstein, Sao Paulo, Brazil; University of Colorado School of Medicine Proteomics Core Facility (K.H.) and Department of Pediatrics (C.C.S.), School of Medicine, University of Colorado Denver, Aurora; Vitalant Research Division (C.C.S.), Denver, Colorado; and Department of Vascular Surgery (C.J.F.), School of Medicine, University of Maryland, Baltimore, Maryland. FAU - Moore, Ernest E AU - Moore EE FAU - Sauaia, Angela AU - Sauaia A FAU - Carani, Pedro H AU - Carani PH FAU - Schaid, Terry R Jr AU - Schaid TR Jr FAU - DeBot, Margot AU - DeBot M FAU - Fragoso, Miguel AU - Fragoso M FAU - Ghasabyan, Arsen AU - Ghasabyan A FAU - Hansen, Kirk AU - Hansen K FAU - Cohen, Mitchell J AU - Cohen MJ FAU - Silliman, Christopher C AU - Silliman CC FAU - Fox, Charles J AU - Fox CJ LA - eng GR - RM1 GM131968/GM/NIGMS NIH HHS/United States GR - T32 GM008315/GM/NIGMS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20230206 PL - United States TA - J Trauma Acute Care Surg JT - The journal of trauma and acute care surgery JID - 101570622 RN - EC 3.4.21.68 (Tissue Plasminogen Activator) SB - IM MH - Male MH - Animals MH - Swine MH - Tissue Plasminogen Activator MH - Multiple Organ Failure MH - Aorta MH - *Shock, Hemorrhagic/complications/therapy MH - Resuscitation/methods MH - Reperfusion MH - *Blood Coagulation Disorders/etiology/prevention & control MH - *Multiple Trauma/complications/therapy MH - Ischemia MH - *Balloon Occlusion/methods MH - Cerebrovascular Circulation MH - *Endovascular Procedures/methods MH - Disease Models, Animal PMC - PMC10133017 MID - NIHMS1870053 COIS- Conflict of interest/Disclosure: E.E.M. has patents pending related to coagulation and fibrinolysis diagnostics and therapeutic fibrinolytics and is a cofounder with stock options in ThromboTherepeutics. E.E.M. has received grant support from Haemonetics, Inc., Stago, Hemosonics, Instrumentation Laboratories, Inc, and Diapharma outside the submitted work. C.J.F is a on the Clinical Advisory Board for Prytime Medical Devices. EDAT- 2023/02/08 06:00 MHDA- 2023/04/28 06:42 PMCR- 2024/05/01 CRDT- 2023/02/07 12:22 PHST- 2023/04/28 06:42 [medline] PHST- 2023/02/08 06:00 [pubmed] PHST- 2023/02/07 12:22 [entrez] PHST- 2024/05/01 00:00 [pmc-release] AID - 01586154-202305000-00015 [pii] AID - 10.1097/TA.0000000000003894 [doi] PST - ppublish SO - J Trauma Acute Care Surg. 2023 May 1;94(5):718-724. doi: 10.1097/TA.0000000000003894. Epub 2023 Feb 6.