From the Department of General Surgery (G.E.C., G.D.S., N.T.P.P., A.S.G., J.A.P.N., L.P.N.) and Department of Vascular and Endovascular Surgery (M.R.L., J.W.P., T.K.W.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina; Division of Emergency Medicine (M.A.J.), University of Utah School of Medicine, Salt Lake City, Utah; Department of Biomedical Engineering (E.R.), Wake Forest University School of Medicine; and Department of Cardiothoracic Surgery (J.E.J.), Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina.
J Trauma Acute Care Surg. 2023 Aug 1;95(2):205-212. doi: 10.1097/TA.0000000000003962. Epub 2023 Apr 11.
Partial and intermittent resuscitative endovascular balloon occlusion of the aorta (pREBOA and iREBOA, respectively) are lifesaving techniques designed to extend therapeutic duration, mitigate ischemia, and bridge patients to definitive hemorrhage control. We hypothesized that automated pREBOA balloon titration compared with automated iREBOA would reduce blood loss and hypotensive episodes over a 90-minute intervention phase compared with iREBOA in an uncontrolled liver hemorrhage swine model.
Twenty-four pigs underwent an uncontrolled hemorrhage by liver transection and were randomized to automated pREBOA (n = 8), iREBOA (n = 8), or control (n = 8). Once hemorrhagic shock criteria were met, controls had the REBOA catheter removed and received transfusions only for hypotension. The REBOA groups received 90 minutes of either iREBOA or pREBOA therapy. Surgical hemostasis was obtained, hemorrhage volume was quantified, and animals were transfused to euvolemia and then underwent 1.5 hours of automated critical care.
The control group had significantly higher mortality rate (5 of 8) compared with no deaths in both REBOA groups, demonstrating that the liver injury is highly lethal ( p = 0.03). During the intervention phase, animals in the iREBOA group spent a greater proportion of time in hypotension than the pREBOA group (20.7% [16.2-24.8%] vs. 0.76% [0.43-1.14%]; p < 0.001). The iREBOA group required significantly more transfusions than pREBOA (21.0 [20.0-24.9] mL/kg vs. 12.1 [9.5-13.9] mL/kg; p = 0.01). At surgical hemostasis, iREBOA had significantly higher hemorrhage volumes compared with pREBOA (39.2 [29.7-44.95] mL/kg vs. 24.7 [21.6-30.8] mL/kg; p = 0.04).
Partial REBOA animals spent significantly less time at hypotension and had decreased transfusions and blood loss. Both pREBOA and iREBOA prevented immediate death compared with controls. Further refinement of automated pREBOA is necessary, and controller algorithms may serve as vital control inputs for automated transfusion.
Therapeutic/Care Management; Level III.
部分和间歇性的主动脉球囊阻断复苏（分别为 pREBOA 和 iREBOA）是挽救生命的技术，旨在延长治疗时间、减轻缺血，并将患者桥接至确定性出血控制。我们假设与 iREBOA 相比，自动 pREBOA 球囊滴定在未经控制的肝出血猪模型中，与 iREBOA 相比，在 90 分钟的干预阶段会减少失血量和低血压发作。
24 头猪通过肝横断造成不受控制的出血，并随机分为自动 pREBOA（n = 8）、iREBOA（n = 8）或对照组（n = 8）。一旦达到出血性休克标准，对照组将 REBOA 导管取出，仅在低血压时进行输血。REBOA 组接受 90 分钟的 iREBOA 或 pREBOA 治疗。获得手术止血，量化出血量，然后将动物输血至血容量正常，然后进行 1.5 小时的自动重症监护。
对照组的死亡率明显高于 REBOA 两组（5/8），表明肝损伤是高度致命的（p = 0.03）。在干预阶段，iREBOA 组动物低血压的时间比例明显高于 pREBOA 组（20.7%[16.2-24.8%] vs. 0.76%[0.43-1.14%]；p <0.001）。iREBOA 组需要的输血明显多于 pREBOA（21.0[20.0-24.9]mL/kg vs. 12.1[9.5-13.9]mL/kg；p = 0.01）。在手术止血时，iREBOA 的出血量明显高于 pREBOA（39.2[29.7-44.95]mL/kg vs. 24.7[21.6-30.8]mL/kg；p = 0.04）。
部分 REBOA 动物低血压时间明显缩短，输血和出血量减少。与对照组相比，pREBOA 和 iREBOA 均能预防即刻死亡。需要进一步改进自动 pREBOA，控制器算法可能作为自动输血的重要控制输入。
治疗/护理管理；三级。
