Ultra-early resuscitative endovascular balloon occlusion of the aorta for hemorrhagic shock in a pig model
Objective To construct a standardized resuscitative endovascular balloon occlusion of the aorta(REBOA)damage control resuscitation model for hemorrhagic shock in pigs.Methods Ten Yorkshire pigs of ei-ther sex weighing(39.0±3.0)kg were used.Two pigs were randomly selected for preliminary experiment,and the other 8 pigs were randomly divided into control group and REBOA group by sealed envelope.For each group,4 pigs were designed but only 2 pigs succeeded in the hemorrhagic shock model,which was developed by bloodletting 45％of the autologous volume via the primary branches of the superior mesenteric artery.Both groups received damage control fluid resuscitation,including fluid infusion to increase volume and medication to raise the blood pressure.In the REBOA group,REBOA was additionally conducted to control bleeding:40 min blockade+10 min balloon relax-ation to restore blood perfusion below the diaphragm,and repeated for 3 cycles.The start of experiment was recorded as T0,start of damage control resuscitation as T1(10 min after modeling),and T2,T3,T4 and T5(end observation timepoint)every 1 h after treatment.The HR,MAP,PH,lactic acid(Lac)and standard base excess(SBE)were recorded at all the 6 time points while Hb,HCT,PT,APTT and FIB at T0,T1,T4,and T5.Results Compared with the control group,the REBOA group showed better hemodynamics and circulatory metabolism,mainly manifested as milder changes in HR,MAP,pH,Lac,and SBE during the period of T1-T5,with the difference being 53.0 vs.116.0 for HR(bpm),47.0 vs.66.0 for MAP(mmHg),0.37 vs.0.50 for pH,10.6 vs.15.0 for Lac(mmol/L),and 21.6 vs.25.1 for SBE(mmol/L).Moreover,at the observation endpoint of T5,the REBOA group revealed better results than the control group(HR,bpm,89.0 vs.50.0;MAP,mmHg,78.0 vs.27.0;pH 7.23 vs.6.90;Lac,mmol/L,6.6 vs.16.9;SBE,mmol/L,-6.1 vs.-18.9).The REBOA group also showed higher levels of Hb and HCT at T4 and T5,and better coagulation function as higher APTT and FIB but similar PT at the observation end-point of T5.Conclusion Ultra-early application of REBOA for damage control resuscitation is effective for severe bleeding and non-compressible torso hemorrhage.This study may provide a standardized animal model for further studies of REBOA.
Severe traumaResuscitative endovascular balloon occlusion of the aortaHemorrhagic shockDamage control resuscitationPig
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