Newberry Ryan K, Paredes R Madelaine, Barnard Ed B G, Redman Theodore T, Arana Allyson A, Maddry Joseph K, Glaser Jacob J, Rall Jason M
BerbeeWalsh Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2025 Jan 16;190(1-2):e149-e156. doi: 10.1093/milmed/usae305.
Uncontrolled torso hemorrhage is the primary cause of potentially survivable deaths on the battlefield. Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), in conjunction with damage control resuscitation, may be an effective management strategy for these patients in the prehospital or austere phase of their care. However, the effect of whole blood (WB) transfusion during REBOA on post-occlusion circulatory collapse is not fully understood.
Yorkshire male swine (n = 6 per group, 70-90 kg) underwent a 40% volume-controlled hemorrhage. After a 10-minute hemorrhagic shock period, a REBOA balloon was inflated in Zone 1. Fifteen minutes after inflation, 0, 1, or 3 units (450 mL/unit) of autologous WB was infused through the left jugular vein. Thirty minutes after initial balloon inflation, the balloon was deflated slowly over 3 minutes. Following deflation, normal saline was administered (up to 3,000 mL) and swine were observed for 2 hours. Survival (primary outcome), hemodynamics, and blood gas values were compared among groups. Statistical significance was determined by log-rank test, one-way ANOVA, and repeated measures ANOVA.
Survival rates were comparable between groups (P = .345) with 66% of control, 33% of the one-unit animals, and 50% of the 3-unit animals survived until the end of the study. Following WB infusion, both the 1-unit and the 3-unit groups had significantly higher blood pressure (P < .01), pulmonary artery pressure (P < .01), and carotid artery flow (P < .01) compared to the control group.
WB transfusion during Zone 1 REBOA was not associated with increased short-term survival in this large animal model of severe hemorrhage. We observed no signal that WB transfusion may mitigate post-occlusion circulatory collapse. However, there was evidence of supra-normal blood pressures during WB transfusion.
未得到控制的躯干出血是战场上潜在可救治死亡的主要原因。1区主动脉复苏性血管内球囊阻断术（REBOA）联合损伤控制复苏，可能是这些患者在院前或简易治疗阶段的有效管理策略。然而，REBOA期间输注全血（WB）对球囊阻断后循环衰竭的影响尚未完全明确。
约克夏雄性猪（每组6只，70 - 90千克）经历40%容量控制出血。在10分钟失血性休克期后，在1区充盈REBOA球囊。充盈15分钟后，通过左颈静脉输注0、1或3单位（450毫升/单位）自体WB。首次球囊充盈30分钟后，在3分钟内缓慢放气。放气后，给予生理盐水（最多3000毫升），观察猪2小时。比较各组的生存率（主要结局）、血流动力学和血气值。通过对数秩检验、单因素方差分析和重复测量方差分析确定统计学显著性。
各组生存率相当（P = 0.345），对照组66%、1单位组33%、3单位组50%存活至研究结束。输注WB后，1单位组和3单位组的血压（P < 0.01）、肺动脉压（P < 0.01）和颈动脉血流（P < 0.01）均显著高于对照组。
在这个严重出血的大型动物模型中，1区REBOA期间输注WB与短期生存率增加无关。我们未观察到WB输注可减轻球囊阻断后循环衰竭的迹象。然而，有证据表明输注WB期间血压超正常。
