From the University of Nevada Medical School (J.M.), Reno, Nevada; Department of Surgery (N.T.P.P.), Department of Cardiothoracic Surgery (M.R.L.), Department of Vascular/Endovascular Surgery (T.K.W.), and Department of Pediatric Surgery (L.P.N.), Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; and Division of Emergency Medicine (M.A.J.), University of Utah, Salt Lake City, Utah.
J Trauma Acute Care Surg. 2022 Aug 1;93(2S Suppl 1):S94-S101. doi: 10.1097/TA.0000000000003667. Epub 2022 May 12.
Partial resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown promise as a method to extend REBOA, but there lacks a standard definition of the technique. The purpose of this study was to investigate the relationships between distal and proximal mean arterial pressure (MAP) and distal aortic flow past a REBOA catheter. We hypothesize that a relationship between distal aortic flow and distal MAP in Zone 1 partial REBOA (pREBOA) is conserved and that there is no apparent relationship between aortic flow and proximal MAP.
A retrospective data analysis of swine was performed. Cohort 1 underwent 20% controlled hemorrhage and then randomized to aortic flow of 400 mL/min or complete occlusion for 20 minutes (n = 11). Cohort 2 underwent 30% controlled hemorrhage followed by complete aortic occlusion for 30 minutes (n = 29). Then, they all underwent REBOA wean in a similar stepwise fashion. Blood pressure was collected from above (proximal) and below (distal) the REBOA balloon. Aortic flow was measured using a surgically implanted supraceliac aortic perivascular flow probe. The time period of balloon wean was taken as the time point of interest.
A linear relationship between distal MAP and aortic flow was observed ( R2 value, 0.80), while no apparent relationship appeared between proximal MAP and aortic flow ( R2 value, 0.29). The repeated-measures correlation coefficient for distal MAP (0.94; 95% confidence interval, 0.94-0.94) was greater than proximal MAP (-0.73; 95% confidence interval, -0.74 to -0.72).
The relationship between MAP and flow will be a component of next-generation pREBOA control inputs. This study provides evidence that pREBOA techniques should rely on distal rather than proximal MAP for control of distal aortic flow. These data could inform future inquiry into optimal flow rates and parameters based on distal MAP in both translational and clinical contexts.
部分主动脉球囊阻断复苏（REBOA）已显示出作为延长 REBOA 方法的潜力，但该技术缺乏标准定义。本研究旨在探讨 REBOA 导管远端和近端平均动脉压（MAP）与远端主动脉血流之间的关系。我们假设在 1 区部分 REBOA（pREBOA）中，远端主动脉血流与远端 MAP 之间存在关系，并且主动脉血流与近端 MAP 之间没有明显关系。
对猪进行回顾性数据分析。第 1 组进行 20%控制性出血，然后随机分为主动脉流量 400mL/min 或完全阻断 20 分钟（n=11）。第 2 组进行 30%控制性出血，然后完全阻断 30 分钟（n=29）。然后，它们都以类似的逐步方式进行 REBOA 脱机。血压在球囊上方（近端）和下方（远端）采集。使用植入的腹主动脉旁血管周流量探头测量主动脉流量。球囊脱机的时间段为感兴趣的时间点。
观察到远端 MAP 与主动脉流量之间存在线性关系（R2 值，0.80），而近端 MAP 与主动脉流量之间似乎没有明显关系（R2 值，0.29）。远端 MAP 的重复测量相关系数为 0.94（95%置信区间，0.94-0.94），大于近端 MAP 的-0.73（95%置信区间，-0.74 至-0.72）。
MAP 与流量之间的关系将成为下一代 pREBOA 控制输入的组成部分。本研究提供了证据，表明 pREBOA 技术应依赖远端而不是近端 MAP 来控制远端主动脉血流。这些数据可以为未来基于远端 MAP 的在转化和临床环境中的最佳流量和参数的研究提供信息。
