Li Yansong, Dubick Michael A, Yang Zhangsheng, Barr Johnny L, Gremmer Brandon J, Lucas Michael L, Necsoiu Corina, Jordan Bryan S, Batchinsky Andriy I, Cancio Leopoldo C
Department of Expeditionary Critical Care Research, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America.
Department of Damage Control Resuscitation, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States of America.
PLoS One. 2020 Nov 17;15(11):e0242450. doi: 10.1371/journal.pone.0242450. eCollection 2020.
Resuscitative Endovascular Balloon Occlusion of Aorta (REBOA) has emerged as a potential life-saving maneuver for the management of non-compressible torso hemorrhage in trauma patients. Complete REBOA (cREBOA) is inherently associated with the burden of ischemia reperfusion injury (IRI) and organ dysfunction. However, the distal organ inflammation and its association with organ injury have been little investigated. This study was conducted to assess these adverse effects of cREBOA following massive hemorrhage in swine.
Spontaneously breathing and consciously sedated Sinclair pigs were subjected to exponential hemorrhage of 65% total blood volume over 60 minutes. Animals were randomized into 3 groups (n = 7): (1) Positive control (PC) received immediate transfusion of shed blood after hemorrhage, (2) 30min-cREBOA (A30) received Zone 1 cREBOA for 30 minutes, and (3) 60min-cREBOA (A60) given Zone 1 cREBOA for 60 minutes. The A30 and A60 groups were followed by resuscitation with shed blood post-cREBOA and observed for 4h. Metabolic and hemodynamic effects, coagulation parameters, inflammatory and end organ consequences were monitored and assessed.
Compared with 30min-cREBOA, 60min-cREBOA resulted in (1) increased IL-6, TNF-α, and IL-1β in distal organs (kidney, jejunum, and liver) (p < 0.05) and decreased reduced glutathione in kidney and liver (p < 0.05), (2) leukopenia, neutropenia, and coagulopathy (p < 0.05), (3) blood pressure decline (p < 0.05), (4) metabolic acidosis and hyperkalemia (p < 0.05), and (5) histological injury of kidney and jejunum (p < 0.05) as well as higher levels of creatinine, AST, and ALT (p < 0.05).
30min-cREBOA seems to be a feasible and effective adjunct in supporting central perfusion during severe hemorrhage. However, prolonged cREBOA (60min) adverse effects such as distal organ inflammation and injury must be taken into serious consideration.
复苏性血管内主动脉球囊阻断术（REBOA）已成为创伤患者不可压缩性躯干出血管理中一种潜在的挽救生命的操作。完全性REBOA（cREBOA）本质上与缺血再灌注损伤（IRI）和器官功能障碍的负担相关。然而，远端器官炎症及其与器官损伤的关联鲜有研究。本研究旨在评估猪大出血后cREBOA的这些不良反应。
将自主呼吸且清醒镇静的辛克莱猪在60分钟内进行相当于总血容量65%的指数性出血。动物被随机分为3组（n = 7）：（1）阳性对照组（PC）在出血后立即输注失血，（2）30分钟cREBOA组（A30）进行1区cREBOA 30分钟，（3）60分钟cREBOA组（A60）进行1区cREBOA 60分钟。A30组和A60组在cREBOA后用失血进行复苏，并观察4小时。监测并评估代谢和血流动力学效应、凝血参数、炎症反应和终末器官后果。
与30分钟cREBOA相比，60分钟cREBOA导致（1）远端器官（肾脏、空肠和肝脏）中白细胞介素-6、肿瘤坏死因子-α和白细胞介素-1β增加（p < 0.05），肾脏和肝脏中还原型谷胱甘肽减少（p < 0.05），（2）白细胞减少、中性粒细胞减少和凝血病（p < 0.05），（3）血压下降（p < 0.05），（4）代谢性酸中毒和高钾血症（p < 0.05），以及（5）肾脏和空肠的组织学损伤（p < 0.05）以及肌酐、谷草转氨酶和谷丙转氨酶水平升高（p < 0.05）。
30分钟cREBOA似乎是严重出血期间支持中心灌注的一种可行且有效的辅助手段。然而，必须认真考虑延长cREBOA（60分钟）的不良反应，如远端器官炎症和损伤。
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