Abstract
IntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) may be used in severely injured patients with uncontrollable bleeding. However, zone-dependent effects of REBOA are rarely described. We compared the short-term zone- and organ-specific microcirculatory changes in abdominal organs and the extremity during occlusion of the aorta in a standardized porcine model.MethodsMale pigs were placed under general anesthesia, for median laparotomy to expose intra-abdominal organs. REBOA placement occurred in Zone 1 (from origin left subclavian artery to celiac trunk), Zone 2 (between the coeliac trunk and most caudal renal artery) and Zone 3 (distal most caudal renal artery to aortic bifurcation). Local microcirculation of the intra-abdominal organs were measured at the stomach, colon, small intestine, liver, and kidneys. Furthermore, the right medial vastus muscle was included for assessment. Microcirculation was measured using oxygen-to-see device (arbitrary units, A.U). Invasive blood pressure measurements were recorded in the carotid and femoral artery (ipsilateral). Ischemia/Reperfusion (I/R)-time was 10 min with complete occlusion.ResultsAt baseline, microcirculation of intra-abdominal organs differed significantly (p < 0.001), the highest flow was in the kidneys (208.3 ± 32.9 A.U), followed by the colon (205.7 ± 36.2 A.U.). At occlusion in Zone 1, all truncal organs showed significant decreases (p < 0.001) in microcirculation, by 75% at the colon, and 44% at the stomach. Flow-rate changes at the extremities were non-significant (n.s). During occlusion in Zone 2, a significant decrease (p < 0.001) in microcirculation was observed at the colon (− 78%), small intestine (− 53%) and kidney (− 65%). The microcirculatory changes at the extremity were n.s. During occlusion in Zone 3, truncal and extremity microcirculatory changes were n.s.ConclusionAll abdominal organs showed significant changes in microcirculation during REBOA. The intra-abdominal organs react differently to the same occlusion, whereas local microcirculation in extremities appeared to be unaffected by short-time REBOA, regardless of the zone of occlusion.
Highlights
Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be used in severely injured patients with uncontrollable bleeding
REBOA serves as a hemorrhage control and resuscitation adjunct to prevent cardiovascular collapse [9]
Depending on the bleeding source, REBOA may be performed at three different zones: Zone 1 ranges from the left subclavian artery to the coeliac trunk; Zone 2 ranges from the celiac trunk to the most caudal renal artery, and Zone 3 extends from the most caudal renal artery to the aortic bifurcation [8, 9]
Summary
Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be used in severely injured patients with uncontrollable bleeding. Hemorrhagic control by external pressure, tourniquet [2], or open surgery [3] are the commonly used interventions, endovascular techniques have recently gained considerable more acceptance. The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) as a modern clinical practice, adds a promising adjunct to the acute treatment of major blood loss in the abdomen or the pelvis [8], with successful elevation of central blood pressure during shock [9]. REBOA serves as a hemorrhage control and resuscitation adjunct to prevent cardiovascular collapse [9]. REBOA increases resuscitation times, preventing hemorrhaging by up to 60 min [8, 10]
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