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Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?
Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
R. Adams Cowley Shock Trauma Center, University of Maryland, Baltimore MD, United States; Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Department of War Surgery, Kirov Military Medical Academy, Saint-Petersburg, Russian Federation.
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2018 (English)In: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941, Vol. 44, no 4, p. 511-518Article in journal (Refereed) Published
Abstract [en]

The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock.

Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage.

Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals.

In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2018. Vol. 44, no 4, p. 511-518
Keywords [en]
Resuscitative endovascular balloon occlusion of the aorta, REBOA, Hemorrhagic shock, Ovine model, Ischemia-reperfusion injury
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:oru:diva-68547DOI: 10.1007/s00068-016-0732-zISI: 000440981100004PubMedID: 27738726Scopus ID: 2-s2.0-84991086734OAI: oai:DiVA.org:oru-68547DiVA, id: diva2:1240670
Conference
17th Congress of the European-Society-for-Trauma-and-Emergency-Surgery, Vienna, Austria, April 26, 2016
Note

Funding Agency:

President of Russia  MK-7508.2016.7

Available from: 2018-08-22 Created: 2018-08-22 Last updated: 2018-09-14Bibliographically approved

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Hörer, Tal M.

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