From the Department of Emergency Medicine (M.H.T., B.M.M., C.I.C., D.C.L., N.L.G., K.R.W.), Michigan Center for Integrative Research in Critical Care (M.H.T., B.M.M., C.I.C., J.S.P., D.C.L., N.L.G., S.C.W., A.J.S., J.L.E., K.R.W.), Biomedical Engineering (J.S.P., A.J.S., K.R.W.), Mechanical Engineering (J.S.P., A.J.S.), and Department of Surgery (J.S.P., S.C.W., J.L.E.), University of Michigan, Ann Arbor, Michigan.
J Trauma Acute Care Surg. 2020 Dec;89(6):1114-1123. doi: 10.1097/TA.0000000000002867.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been shown to be effective for management of noncompressible torso hemorrhage. However, this technique requires arterial cannulation, which can be time-consuming and not amendable to placement in austere environments. We present a novel, less invasive aortic occlusion device and technique designated gastroesophageal resuscitative occlusion of the aorta (GROA). In this study, we aimed to characterize the physiological tolerance and hemodynamic effects of a prototype GROA device in a model of severe hemorrhagic shock and resuscitation and compare with REBOA.
Swine (N = 47) were surgically instrumented for data collection. A 35% controlled arterial hemorrhage was followed by randomizing animals to 30-minute, 60-minute, or 90-minute interventions of GROA, REBOA, or control. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional 4 hours.
All animals except one GROA 90-minute application survived the duration of their intervention periods. Survival through resuscitation phase in GROA, REBOA, and control groups was similar in the 30-minute and 60-minute groups. The 90-minute occlusion groups exhibited deleterious effects upon device deactivation and reperfusion with two GROA animals surviving and no REBOA animals surviving. Mean (SD) arterial pressure in GROA and REBOA animals increased across all groups to 98 (31.50) mm Hg and 122 (24.79) mm Hg, respectively, following intervention. Lactate was elevated across all GROA and REBOA groups relative to controls during intervention but cleared by 4 hours in the 30-minute and 60-minute groups. Postmortem histological examination of the gastric mucosa revealed mild to moderate inflammation across all GROA groups.
In this study, the hemodynamic effects and physiological tolerance of GROA was similar to REBOA. The GROA device was capable of achieving high zone II full aortic occlusion and may be able to serve as an effective method of aortic impingement.
复苏性血管内主动脉球囊阻断（REBOA）已被证明对非压缩性躯干出血的治疗有效。然而，该技术需要动脉插管，这可能很耗时，并且不适用于简陋环境下的放置。我们提出了一种新颖的、微创的主动脉阻断装置和技术，称为胃食管复苏性主动脉阻断（GROA）。在这项研究中，我们旨在描述一种原型 GROA 装置在严重出血性休克和复苏模型中的生理耐受性和血液动力学效应，并与 REBOA 进行比较。
对猪（N=47）进行手术以进行数据收集。进行 35%的控制性动脉出血后，随机将动物分为 GROA、REBOA 或对照组 30 分钟、60 分钟或 90 分钟干预组。干预后，停用装置，动物接受全血和晶体液复苏。动物再监测 4 小时。
除 1 只 GROA 90 分钟应用动物外，所有动物均在干预期间存活。在 30 分钟和 60 分钟组中，GROA、REBOA 和对照组的所有动物在复苏阶段的存活率相似。90 分钟的闭塞组在装置停用和再灌注时表现出有害影响，2 只 GROA 动物存活，没有 REBOA 动物存活。GROA 和 REBOA 动物的平均动脉压在所有组中均升高，干预后分别为 98（31.50）mmHg 和 122（24.79）mmHg。在所有 GROA 和 REBOA 组中，与对照组相比，乳酸在干预期间升高，但在 30 分钟和 60 分钟组中在 4 小时时清除。所有 GROA 组的胃黏膜组织学检查显示轻度至中度炎症。
在这项研究中，GROA 的血液动力学效应和生理耐受性与 REBOA 相似。GROA 装置能够实现高区域 II 全主动脉闭塞，可能成为一种有效的主动脉压迫方法。
