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Hörer, Tal M.
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Publications (10 of 117) Show all publications
Ordoñez, C. A., Parra, M. W., Caicedo, Y., Rodríguez-Holguín, F., García, A. F., Serna, J. J., . . . Brenner, M. (2024). Critical systolic blood pressure threshold for endovascular aortic occlusion: A multinational analysis to determine when to place a REBOA. Journal of Trauma and Acute Care Surgery, 96(2), 247-255
Open this publication in new window or tab >>Critical systolic blood pressure threshold for endovascular aortic occlusion: A multinational analysis to determine when to place a REBOA
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2024 (English)In: Journal of Trauma and Acute Care Surgery, ISSN 2163-0755, E-ISSN 2163-0763, Vol. 96, no 2, p. 247-255Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Systolic blood pressure (SBP) is a potential indicator that could guide when to use a resuscitative endovascular balloon occlusion of the aorta (REBOA) in trauma patients with life-threatening injuries. This study aims to determine the optimal SBP threshold for REBOA placement by analyzing the association between SBP pre-REBOA and 24-hour mortality in severely injured hemodynamically unstable trauma patients.

METHODS: We performed a pooled analysis of the Aortic Balloon Occlusion (ABO) trauma and AORTA registries. These databases record the details related to the use of REBOA and include data from 14 countries worldwide. We included patients who had suffered penetrating and/or blunt trauma. Patients who arrived at the hospital with a SBP pre-REBOA of 0 mm Hg and remained at 0 mm Hg after balloon inflation were excluded. We evaluated the impact that SBP pre-REBOA had on the probability of death in the first 24 hours.

RESULTS: A total of 1107 patients underwent endovascular aortic occlusion, of these, 848 met inclusion criteria. The median age was 44 years [IQR, 27-59 years] and 643(76%) were male. The median injury severity score was 34 [IQR, 25-45]. The median SBP pre-REBOA was 65 mm Hg [IQR: 49-88 mm Hg]. Mortality at 24-hours was reported in 279 (32%) patients. Math modelling shows that predicted probabilities of the primary outcome increased steadily in SBP pre-REBOA below 100 mm Hg. Multivariable mixed-effects analysis shows that when SBP pre-REBOA was lower than 60 mm Hg, the risk of death was more than 50% (relative risk, 1.5; 95%CI, 1.17-1.92; P = .001).

DISCUSSION: In patients who do not respond to initial resuscitation, the use of REBOA in SBP's between 60- and 80-mm Hg may be a useful tool in resuscitation efforts before further decompensation or complete cardiovascular collapse. The findings from our study are clinically important as a first step in identifying candidates for REBOA.

STUDY TYPE: Observational Study. LEVEL OF EVIDENCE: Level IV.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-109261 (URN)10.1097/TA.0000000000004160 (DOI)37853558 (PubMedID)
Available from: 2023-10-19 Created: 2023-10-19 Last updated: 2024-01-29Bibliographically approved
Paran, M., McGreevy, D., Hörer, T. M., Khan, M., Dudkiewicz, M. & Kessel, B. (2024). International registry on aortic balloon occlusion in major trauma: Partial inflation does not improve outcomes in abdominal trauma. The Surgeon, 22(1), 37-42
Open this publication in new window or tab >>International registry on aortic balloon occlusion in major trauma: Partial inflation does not improve outcomes in abdominal trauma
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2024 (English)In: The Surgeon, ISSN 1479-666X, Vol. 22, no 1, p. 37-42Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a method for temporary hemorrhage control used in haemodynamically unwell patients with severe bleeding. In haemodynamically unwell abdominal trauma patients, laparotomy remains the initial procedure of choice. Using REBOA in patients as a bridge to laparotomy is a novel option whose feasibility and efficacy remain unclear. We aimed to assess the clinical outcome in patients with abdominal injury who underwent both REBOA placement and laparotomy.

METHODS: This is a retrospective study, including trauma patients with an isolated abdominal injury who underwent both REBOA placement and laparotomy, during the period 2011-2019. All data were collected via the Aortic Balloon Occlusion Trauma Registry database.

RESULTS: One hundred and three patients were included in this study. The main mechanism of trauma was blunt injury (62.1%) and the median injury severity score (ISS) was 33 (14-74). Renal failure and multi-organ dysfunction syndrome (MODS) occurred in 15.5% and 35% of patients, respectively. Overall, 30-day mortality was 50.5%. Post balloon inflation systolic blood pressure (SBP) >80 mmHg was associated with lower 24-h mortality (p = 0.007). No differences in mortality were found among patients who underwent partial occlusion vs. total occlusion of the aorta.

CONCLUSIONS: Our results support the feasibility of REBOA use in patients with isolated abdominal injury, with survival rates similar to previous reports for haemodynamically unstable abdominal trauma patients. Post-balloon inflation SBP >80 mmHg was associated with a significant reduction in 24-h mortality rates, but not 30-day mortality. Total aortic occlusion was not associated with increased mortality, MODS, and complication rates compared with partial occlusion.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Abdominal trauma, Aortic balloon occlusion, EVTM, Morbidity, Mortality, REBOA
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-108003 (URN)10.1016/j.surge.2023.08.001 (DOI)37652801 (PubMedID)2-s2.0-85169505216 (Scopus ID)
Available from: 2023-09-01 Created: 2023-09-01 Last updated: 2024-01-29Bibliographically approved
McGreevy, D. T., Pirouzram, A., Gidlund, K. D., Nilsson, K. F. & Hörer, T. M. (2023). A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients. Journal of Vascular Surgery, 77(3), 741-749
Open this publication in new window or tab >>A 12-year experience of endovascular repair for ruptured abdominal aortic aneurysms in all patients
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2023 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 77, no 3, p. 741-749Article in journal (Refereed) Published
Abstract [en]

Objective: Endovascular aneurysm repair (EVAR) has been increasingly performed for ruptured abdominal aortic aneurysms (rAAAs). However, multiple randomized trials have failed to demonstrate a survival benefit compared with open aortic surgery. During a 12-year period, 100% of patients without a history of aneurysm surgery had undergone EVAR for a rAAA at orebro University Hospital, with no emergent open aortic surgery performed. In the present study, we evaluated the mortality and technical success during this "EVAR-only" period.

Methods: A single-center, retrospective observational study was conducted. We identified all patients who had presented to Orebro University Hospital with a rAAA between October 2009 and September 2021. Patients with isolated iliac artery, thoracic, and thoracoabdominal aortic ruptures were not included. Patients who had received previous aortic interventions (open or endovascular) and patients who had received palliative treatment instead of surgical intervention were also excluded. The patient characteristics, perioperative and postoperative data, and mortality rate were investigated.

Results: EVAR had been performed in 100 patients. Preoperative hemodynamic instability had been present in 54 patients (54%), and 18 (18%) had undergone aortic balloon occlusion. The aneurysm location was infrarenal in 89 patients (89%). Bifurcated stent grafts had been used in 97 patients (97%), and adjunct endovascular techniques had been used for 27 patients (27%). Of 98 patients, EVAR had been performed with the patient under local anesthesia for 62 patients (63%). Peri-and postoperative complications at 30 days had occurred in 20 of 100 patients (20%) and 22 of 79 patients (28%), respectively. The overall mortality at 30 days was 27% (27 of 100 patients), and the mortality for those with an isolated infrarenal rAAA was 24% (21 of 89 patients). The overall mortality at 1 year was 39% (39 of 100 patients) and for those with an isolated infrarenal rAAA was 37% (33 of 89 patients). The presence of preoperative hemodynamic instability and the use of ABO were statistically significantly and independently associated with increased 30-day mortality on multivariate logistic regression analysis.

Conclusions: All 100 patients who had undergone surgery for a rAAA had been treated using EVAR and endovascular adjuncts, with a relatively low mortality rate, thus continuing the "EVAR-only" approach. A low proportion of rAAA patients were considered surgically unsuitable. These findings support the applicability of EVAR for the treatment of all rAAAs at suitable centers.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Aortic aneurysm, Aortic rupture, Endovascular aortic repair, Endovascular procedures
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-105412 (URN)10.1016/j.jvs.2022.10.032 (DOI)000952530400001 ()37276170 (PubMedID)2-s2.0-85143604283 (Scopus ID)
Available from: 2023-04-12 Created: 2023-04-12 Last updated: 2023-06-19Bibliographically approved
Wikström, M. B., Åström, J., Hurtsén, A. S., Hörer, T. M. & Nilsson, K. F. (2023). A porcine study of ultrasound-guided versus fluoroscopy-guided placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA). Trauma surgery & acute care open, 8(1), Article ID e001075.
Open this publication in new window or tab >>A porcine study of ultrasound-guided versus fluoroscopy-guided placement of endovascular balloons in the inferior vena cava (REBOVC) and the aorta (REBOA)
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2023 (English)In: Trauma surgery & acute care open, E-ISSN 2397-5776, Vol. 8, no 1, article id e001075Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: In fluoroscopy-free settings, alternative safe and quick methods for placing resuscitative endovascular balloon occlusion of the aorta (REBOA) and resuscitative endovascular balloon occlusion of the inferior vena cava (REBOVC) are needed. Ultrasound is being increasingly used to guide the placement of REBOA in the absence of fluoroscopy. Our hypothesis was that ultrasound could be used to adequately visualize the suprahepatic vena cava and guide REBOVC positioning, without significant time-delay, when compared with fluoroscopic guidance, and compared with the corresponding REBOA placement.

METHODS: Nine anesthetized pigs were used to compare ultrasound-guided placement of supraceliac REBOA and suprahepatic REBOVC with corresponding fluoroscopic guidance, in terms of correct placement and speed. Accuracy was controlled by fluoroscopy. Four intervention groups: (1) fluoroscopy REBOA, (2) fluoroscopy REBOVC, (3) ultrasound REBOA and (4) ultrasound REBOVC. The aim was to carry out the four interventions in all animals. Randomization was performed to either fluoroscopic or ultrasound guidance being used first. The time required to position the balloons in the supraceliac aorta or in the suprahepatic inferior vena cava was recorded and compared between the four intervention groups.

RESULTS: Ultrasound-guided REBOA and REBOVC placement was completed in eight animals, respectively. All eight had correctly positioned REBOA and REBOVC on fluoroscopic verification. Fluoroscopy-guided REBOA placement was slightly faster (median 14 s, IQR 13-17 s) than ultrasound-guided REBOA (median 22 s, IQR 21-25 s, p=0.024). The corresponding comparisons of the REBOVC groups were not statistically significant, with fluoroscopy-guided REBOVC taking 19 s, median (IQR 11-22 s) and ultrasound-guided REBOVC taking 28 s, median (IQR 20-34 s, p=0.19).

CONCLUSION: Ultrasound adequately and quickly guide the placement of supraceliac REBOA and suprahepatic REBOVC in a porcine laboratory model, however, safety issues must be considered before use in trauma patients.

LEVEL OF EVIDENCE: Prospective, experimental, animal study. Basic science study.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
multiple trauma, shock, hemorrhagic, ultrasonography, veins
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-105987 (URN)10.1136/tsaco-2022-001075 (DOI)000991834800005 ()37205275 (PubMedID)2-s2.0-85159958333 (Scopus ID)
Available from: 2023-05-22 Created: 2023-05-22 Last updated: 2023-06-07Bibliographically approved
Hurtsén, A. S., McGreevy, D. T., Karlsson, C., Frostell, C. G., Hörer, T. M. & Nilsson, K. F. (2023). A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury. Intensive Care Medicine Experimental, 11(1), Article ID 18.
Open this publication in new window or tab >>A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury
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2023 (English)In: Intensive Care Medicine Experimental, E-ISSN 2197-425X, Vol. 11, no 1, article id 18Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.

MATERIALS AND METHODS: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.

RESULTS: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.

CONCLUSIONS: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Balloon occlusion, Carbon dioxide, Metabolism, Chock, hemorrhagic, Ischemia–reperfusion injury
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-105455 (URN)10.1186/s40635-023-00502-w (DOI)000982807300001 ()37032421 (PubMedID)2-s2.0-85153117195 (Scopus ID)
Available from: 2023-04-14 Created: 2023-04-14 Last updated: 2023-05-26Bibliographically approved
Hörer, T. M. & McGreevy, D. (2023). Alternative Methods for Endovascular and Hybrid Bleeding Control. Journal of Endovascular Resuscitation and Trauma Management (JEVTM), 7(1), 43-44
Open this publication in new window or tab >>Alternative Methods for Endovascular and Hybrid Bleeding Control
2023 (English)In: Journal of Endovascular Resuscitation and Trauma Management (JEVTM), ISSN 2002-7567, Vol. 7, no 1, p. 43-44Article in journal, Editorial material (Other academic) Published
Abstract [en]

Puncture site or vascular access bleeding may be managed with open or endovascular methods. In this paper, we shortly describe alternative methods for endovascular and hybrid bleeding control.

Place, publisher, year, edition, pages
Örebro University Hospital and University i samarbeid med 'Society of Endovascular Resuscitation and Trauma Management', 2023
Keywords
Endovascular, Vascular Access, Bleeding
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107902 (URN)10.26676/jevtm.290 (DOI)001041508600009 ()2-s2.0-85165673585 (Scopus ID)
Available from: 2023-09-05 Created: 2023-09-05 Last updated: 2023-09-05Bibliographically approved
D'Oria, M., Lembo, R., Hörer, T. M., Rasmussen, T., Mani, K., Parlani, G., . . . Bertoglio, L. (2023). An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA). Journal of Endovascular Therapy, Article ID 15266028231217233.
Open this publication in new window or tab >>An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA)
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2023 (English)In: Journal of Endovascular Therapy, ISSN 1526-6028, E-ISSN 1545-1550, article id 15266028231217233Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA).

METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts' responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round's answers was also graded using Cohen's kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa.

RESULTS: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making.

CONCLUSIONS: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology.

CLINICAL IMPACT: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Delphi consensus, aortic aneurysm, balloon occlusion, ruptured aneurysm
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-110373 (URN)10.1177/15266028231217233 (DOI)001117776400001 ()38062565 (PubMedID)2-s2.0-85179301934 (Scopus ID)
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-02-05Bibliographically approved
Buitendag, J., Variawa, S., Diayar, A., Snyders, P., Rademan, P., Allopi, N., . . . ABO Trauma Registry Grp, A. B. (2023). Comparison of Outcomes Relating to REBOA Inflation Zones: Report from the ABO Trauma Registry. Journal of Endovascular Resuscitation and Trauma Management (JEVTM), 7(1), 15-21
Open this publication in new window or tab >>Comparison of Outcomes Relating to REBOA Inflation Zones: Report from the ABO Trauma Registry
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2023 (English)In: Journal of Endovascular Resuscitation and Trauma Management (JEVTM), ISSN 2002-7567, Vol. 7, no 1, p. 15-21Article in journal (Refereed) Published
Abstract [en]

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporary management modality for non-compressible torso haemorrhage that can be deployed in the pre- and intrahospital setting. This study aimed to compare outcomes following balloon placement in the three aortic zones.

Methods: This is a retrospective study using data from the ABO Trauma Registry. Relevant entries from January 2014 to December 2019 were used and stratified into three groups: those who received Zone 1, 2, or 3 balloon placements.

Results: The study sample consisted of 237 patients: 63 (27%) women and 174 (73%) men, median age 35 years. The primary location of the REBOA balloon was in Zone 1 for 180 patients, while it was nine in Zone 2 and 48 in Zone 3. Complication rates and total durations did not differ significantly between inflation zones. Emergency department mortality rates for Zones 1 and 2 patients were significantly higher than for Zone 3 (P = 0.04), but there was no difference between groups in 24-hour and 30-day mortality rates.

Conclusions: REBOA is currently used in the emergency setting for temporary stabilisation of the bleeding patient. In this cohort, balloon placement occurred in all zones of the aorta for similar durations, with no difference in complication rates between zones. Inadvertent Zone 2 placement was not found to be associated with increased complication rates.

Place, publisher, year, edition, pages
Örebro University Hospital and University i samarbeid med 'Society of Endovascular Resuscitation and Trauma Management', 2023
Keywords
REBOA, Trauma, Inflation Zone, Acute Haemorrhage, Endovascular Intervention
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-107919 (URN)10.26676/jevtm.276 (DOI)001041508600004 ()2-s2.0-85165700002 (Scopus ID)
Available from: 2023-08-31 Created: 2023-08-31 Last updated: 2023-08-31Bibliographically approved
Hörer, T. M., Ierardi, A. M., Carriero, S., Lanza, C., Carrafiello, G. & McGreevy, D. (2023). Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes. Seminars in Vascular Surgery, 36(2), 283-299
Open this publication in new window or tab >>Emergent vessel embolization for major traumatic and non-traumatic hemorrhage: Indications, tools and outcomes
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2023 (English)In: Seminars in Vascular Surgery, ISSN 0895-7967, E-ISSN 1558-4518, Vol. 36, no 2, p. 283-299Article, review/survey (Refereed) Published
Abstract [en]

Endovascular embolization of bleeding vessels in trauma and non-trauma patients is frequently used and is an important tool for bleeding control. It is included in the EVTM (endovascular resuscitation and trauma management) concept and its use in patients with hemodynamic instability is increasing. When the correct embolization tool is chosen, a dedicated multidisciplinary team can rapidly and effectively achieve bleeding control. In this article, we will describe the current use and possibilities for embolization of major hemorrhage (traumatic and non-traumatic) and the published data supporting these techniques as part of the EVTM concept.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Bleeding, Embolization, Endovascular, Trauma
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-106379 (URN)10.1053/j.semvascsurg.2023.04.011 (DOI)001035918000001 ()37330241 (PubMedID)2-s2.0-85160318701 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-08-18Bibliographically approved
Dogan, E. M., Axelsson, B., Jauring, O., Hörer, T. M., Nilsson, K. F. & Edström, M. (2023). Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation. Journal of Cardiovascular Translational Research, 16(4), 948-955
Open this publication in new window or tab >>Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation
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2023 (English)In: Journal of Cardiovascular Translational Research, ISSN 1937-5387, E-ISSN 1937-5395, Vol. 16, no 4, p. 948-955Article in journal (Refereed) Published
Abstract [en]

Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.

Place, publisher, year, edition, pages
Springer-Verlag New York, 2023
Keywords
Cardiopulmonary resuscitation, Counterpulsation, Heart arrest, Hemodynamics
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:oru:diva-102657 (URN)10.1007/s12265-022-10343-9 (DOI)000895631500001 ()36481982 (PubMedID)2-s2.0-85143687279 (Scopus ID)
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2023-12-08Bibliographically approved
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