Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

Abstract

The aim of this study is to evaluate the early survival and organ damage following 30 and 60min 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 30min. Animals were randomized into three groups: 60-min REBOA 30min after the bleeding (60-REBOA), 30-min REBOA 60min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80min after the induction of shock. Animals were observed for 24h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage. Two animals of the n-REBOA group died within 90min 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 5.1mEq/l and from 3.7 to 5.1mmol/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, 60min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.