使用双叶部分复苏性主动脉球囊阻断术在长时间治疗高度致命性主动脉损伤方面在后勤上具有优势。
Use of bilobed partial resuscitative endovascular balloon occlusion of the aorta is logistically superior in prolonged management of a highly lethal aortic injury.
机构信息
From the Division of Trauma, Critical Care &Acute Care Surgery, Department of Surgery (J.Z-R., B.B., B.M., E.N.D., S.G.S., J.M.M., A.G., S.J.U., E.A.R., B.M.M., M.A.S.), Oregon Health & Science University, Portland, Oregon; Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio (M.E.T., J.J.G.), Fort Sam Houston, San Antonio, Texas; and Division of Acute Care Surgery, Center for Injury Science, Department of Surgery (J.B.H.), the University of Alabama at Birmingham, Birmingham, Alabama.
出版信息
J Trauma Acute Care Surg. 2020 Sep;89(3):464-473. doi: 10.1097/TA.0000000000002797.
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable technique for management of noncompressible torso hemorrhage. The major limitation of the current unilobed fully occlusive REBOA catheters is below-the-balloon ischemia-reperfusion complications. We hypothesized that partial aortic occlusion with a novel bilobed partial (p)REBOA-PRO would result in the need for less intraaortic balloon adjustments to maintain a distal goal perfusion pressure as compared with currently available unilobed ER-REBOA.
METHODS
Anesthetized (40-50 kg) swine randomized to control (no intervention), ER-REBOA, or pREBOA-PRO underwent supraceliac aortic injury. The REBOA groups underwent catheter placement into zone 1 with initial balloon inflation to full occlusion for 10 minutes followed by gradual deflation to achieve and subsequently maintain half of the baseline below-the-balloon mean arterial pressure (MAP). Physiologic data and blood samples were collected at baseline and then hourly. At 4 hours, the animals were euthanized, total blood loss and urine output were recorded, and tissue samples were collected.
RESULTS
Baseline physiologic data and basic laboratories were similar between groups. Compared with control, interventions similarly prolonged survival from a median of 18 minutes to over 240 minutes with comparable mortality trends. Blood loss was similar between partial ER-REBOA (41%) and pREBOA-PRO (51%). Partial pREBOA-PRO required a significantly lower number of intraaortic balloon adjustments (10 ER-REBOA vs. 3 pREBOA-PRO, p < 0.05) to maintain the target below-the-balloon MAP. The partial ER-REBOA group developed significantly increased hypercapnia, fibrin clot formation on TEG, liver inflammation, and IL-10 expression compared with pREBOA-PRO.
CONCLUSION
In this highly lethal aortic injury model, use of bilobed pREBOA-PRO for a 4-hour partial aortic occlusion was logistically superior to unilobed ER-REBOA. It required less intraaortic balloon adjustments to maintain target MAP and resulted in less inflammation.
背景
主动脉球囊阻断复苏术（REBOA）是一种治疗非压迫性躯干出血的可行技术。目前的单叶完全闭塞性 REBOA 导管的主要局限性在于球囊下方的缺血再灌注并发症。我们假设，与现有的单叶 ER-REBOA 相比，使用新型双叶部分（p）REBOA-PRO 进行部分主动脉阻断将导致需要更少的主动脉内球囊调整来维持远端目标灌注压。
方法
麻醉（40-50 公斤）猪随机分为对照组（无干预）、ER-REBOA 组或 pREBOA-PRO 组，行 supra 主动脉损伤。REBOA 组将导管放置在 1 区，初始球囊充气至完全闭塞 10 分钟，然后逐渐放气至达到并随后维持球囊下方平均动脉压（MAP）的一半。在基线和每小时收集生理数据和血液样本。在 4 小时时，动物被安乐死，记录总失血量和尿量，并收集组织样本。
结果
与对照组相比，干预组同样延长了从中位 18 分钟到超过 240 分钟的存活时间，死亡率趋势相似。部分 ER-REBOA（41%）和 pREBOA-PRO（51%）的失血量相似。与 ER-REBOA 相比，pREBOA-PRO 组需要进行更少的主动脉内球囊调整（10 次 ER-REBOA 与 3 次 pREBOA-PRO，p < 0.05）来维持目标球囊下方 MAP。与 pREBOA-PRO 相比，部分 ER-REBOA 组的二氧化碳分压显著升高、TEG 上纤维蛋白凝块形成、肝脏炎症和 IL-10 表达增加。
结论
在这个高度致命的主动脉损伤模型中，使用双叶 pREBOA-PRO 进行 4 小时的部分主动脉阻断在操作上优于单叶 ER-REBOA。它需要更少的主动脉内球囊调整来维持目标 MAP，并导致更少的炎症。
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