Tiba Mohamad Hakam, McCracken Brendan M, Greer Nicholas L, Cramer Traci A, Colmenero Mahmood Carmen I, Priambada Putra Ketut B, Plott Jeffery S, Shih Albert J, Wang Stewart C, Eliason Jonathan L, Ward Kevin R
From the Department of Emergency Medicine (M.H.T., B.M.M., N.L.G., T.A.C., C.I.C.M., K.R.W.), The Max Harry Weil Institute for Critical Care Research and Innovation (M.H.T., B.M.M., N.L.G., T.A.C., C.I.C.M., J.S.P., A.J.S., S.C.W., J.L.E., K.R.W.), Department of Biomedical Engineering (J.S.P., A.J.S., K.R.W.), Department of Mechanical Engineering (K.B.P.P., J.S.P., A.J.S.), and Department of Surgery (S.C.W., J.L.E.), University of Michigan, Ann Arbor, Michigan.
J Trauma Acute Care Surg. 2023 Jan 1;94(1):148-155. doi: 10.1097/TA.0000000000003719. Epub 2022 Jun 10.
Gastroesophageal resuscitative occlusion of the aorta (GROA) has been shown effective in creating zone II aortic occlusion capable of temporarily improving survival in animal models of lethal noncompressible torso hemorrhage. In this study, tandem application of GROA transitioning to resuscitative endovascular balloon occlusion of the aorta (REBOA) is explored to demonstrate feasibility as a potential point-of-injury bridge to more advanced care, using a swine model of lethal abdominal hemorrhage.
Swine (n = 19) were anesthetized, instrumented, and subjected to a combination of controlled and uncontrolled hemorrhage from a grade-V liver laceration. Animals were designated as intervention (n = 9; GROA to REBOA) or control (n = 10), for 60 minutes. Following intervention, devices were deactivated, and animals received blood and crystalloid resuscitation. Animals were monitored for 4 hours.
Injury resulted in onset of class IV shock in all animals with a mean arterial pressure (SD) of 24.5 (4.11) mm Hg at the start of intervention. Nine of 10 controls died during the intervention period with a median (interquartile) survival time of 8.5 (9.25) minutes. All animals receiving the intervention survived both the 60-minute intervention period demonstrating a significant survival improvement ( p = 0.0007). Transition from GROA to REBOA was successful in all animals with a transition time ranging from 30 to 90 seconds. Mean arterial pressure significantly improved in animals receiving GROA to REBOA for the duration of intervention, regardless of the method of aortic occlusion, with a range of 70.9 (16.04) mm Hg to 101.1 (15.3) mm Hg. Additional hemodynamics, metrics of shock, and oxygenation remained stable during intervention.
Less invasive technologies such as GROA may present an opportunity to control noncompressible torso hemorrhage more rapidly, with a subsequent transition to more advanced care such as REBOA.
在致死性不可压缩性躯干出血的动物模型中，胃食管复苏性主动脉阻断术（GROA）已被证明能有效建立Ⅱ区主动脉阻断，从而暂时提高生存率。在本研究中，使用致死性腹部出血的猪模型，探讨了GROA与复苏性血管内主动脉球囊阻断术（REBOA）联合应用的可行性，以证明其作为潜在的损伤现场桥梁以提供更高级治疗的可行性。
对19头猪进行麻醉、仪器植入，并使其遭受Ⅴ级肝裂伤导致的可控性和不可控性出血。将动物分为干预组（n = 9；GROA转REBOA）或对照组（n = 10），持续60分钟。干预后，停用设备，动物接受血液和晶体液复苏。对动物进行4小时监测。
损伤导致所有动物出现Ⅳ级休克，干预开始时平均动脉压（标准差）为24.5（4.11）mmHg。10只对照组动物中有9只在干预期间死亡，中位（四分位间距）生存时间为8.5（9.25）分钟。所有接受干预的动物均在60分钟的干预期内存活，显示出显著的生存改善（p = 0.0007）。所有动物从GROA成功过渡到REBOA，过渡时间为30至90秒。在干预期间，无论主动脉阻断方法如何，接受GROA转REBOA的动物平均动脉压均显著改善，范围为70.9（16.04）mmHg至101.1（15.3）mmHg。干预期间，其他血流动力学指标、休克指标和氧合保持稳定。
GROA等侵入性较小的技术可能提供一个机会，以便更迅速地控制不可压缩性躯干出血，随后过渡到如REBOA等更高级的治疗。
