Maintaining Zone 1 Occlusion is a Dynamic Process: The Effects of Proximal Pressure and Blood Transfusion During REBOA

• Published in: The American surgeon Vol. 88; no. 7; p. 1496
• Main Authors: Qadri, Hisham I, Patel, Nathan Tp, Ganapathy, Aravindh S, Lane, Magan R, Jordan, James E, Johnson, M Austin, Williams, Timothy K, Neff, Lucas P
• Format: Journal Article
• Language: English
• Published: United States 01.07.2022
• Subjects: Animals; Aorta; Aortic Diseases - complications; Balloon Occlusion - adverse effects; Blood Transfusion; Endovascular Procedures - adverse effects; Hemorrhage - etiology; Humans; Resuscitation; Shock, Hemorrhagic - therapy; Swine; trauma surgery; surgical critical care; acute care surgery; vascular surgery
• ISSN: 1555-9823
• DOI: 10.1177/00031348221082284

Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides hemodynamic support to patients with non-compressible truncal hemorrhage. As cardiac output increases due to aortic occlusion (AO), aortic diameter will increase as a function of compliance, potentially causing unintended flow around the balloon. Swine (N = 10) were instrumented to collect proximal mean arterial blood pressure (pMAP), distal MAP (dMAP), balloon pressure (bP), balloon volume (bV), and distal aortic flow (Qaorta). A 7-Fr automated REBOA catheter was positioned in Zone 1. At T0, animals underwent 30% total blood volume hemorrhage over 30 min followed by balloon inflation to complete AO. Automated balloon inflation occurred from T30-T60 when Qaorta was detected. Period of interest was T55-T60, while the balloon actively worked to maintain AO during transfusion of shed blood. Median weight of the cohort was 73.75 [IQR:71.58-74.45] kg. During T40-T55 and T55-T60, median pMAP was 88.95 [IQR:76.80-109.92] and 108.13 [IQR:99.13-119.51] mmHg, = 0.07. Median Qaorta during T40-T55, and T55-T60 was 0.81 [IQR:0.41-0.96], and 1.53 [IQR:1.07-1.96] mL/kg/min, = 0.06. Median number of balloon inflations during T40-T55 was 0.00 [IQR:0.00-0.75] and increased during active transfusion to 10.00 [IQR:5.25-14.00], = 0.001. In clinical practice, following initial establishment of AO, progressive balloon inflations are required to maintain AO in response to intrinsic and transfusion-mediated increases in cardiac output, blood pressure, and aortic diameter.