Neidert Leslie E, Morgan Clifford G, Lonowski Dominic, Castro Cecilia, Hemond Peter J, Lozano Valeria R, Tiller Michael M, Cardin Sylvain, Glaser Jacob J
Expeditionary and Trauma Medicine, Naval Medical Research Unit San Antonio, JBSA-Fort Sam Houston, Texas, USA.
Brooke Army Medical Center, JBSA-Fort Sam Houston, Texas, USA.
Trauma Surg Acute Care Open. 2025 Jan 28;10(1):e001559. doi: 10.1136/tsaco-2024-001559. eCollection 2025.
Non-compressible torso hemorrhage (NCTH) represents a leading cause of preventable mortality in trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) stabilizes NCTH but may predispose patients to thrombus generation. REBOA must therefore be prospectively evaluated for coagulation risks with concomitant usage of anti-fibrinolytic tranexamic acid (TXA). Using a porcine model of hemorrhage, it was hypothesized that TXA with REBOA would worsen coagulation outcomes and organ damage.
Thirty-two male Yorkshire swine underwent 30% blood volume hemorrhage with randomization to vehicle control (VC; normal saline), VC+REBOA, TXA, or TXA+REBOA. At T0, animals received 10 mL/minute of group-specific infusion (GSI) followed at T10 by 500 mL of whole blood (WB), second GSI at 13 mL/hour, and Zone 1 REBOA inflation in REBOA groups. At T40, REBOA was deflated, with additional 500 mL WB, and continuation of GSI for 3 hours. Physiological, coagulation, and inflammatory parameters were measured throughout the protocol, with postmortem histopathology.
After REBOA deflation at T40, lactate was significantly higher for the REBOA groups versus the non-REBOA groups, and pH, bicarbonate, and base excess were all significantly lower than the non-REBOA groups. There were no significant differences observed between groups in coagulation, inflammatory, metabolic, or histopathologic parameters.
Administration of TXA with REBOA did not cause more deleterious coagulation outcomes. All significant changes were expected results of REBOA ischemia, and not attributable to TXA treatment. This suggests NCTH can safely be treated with both hemorrhage control methods without exacerbating clotting outcomes.
Not applicable-basic animal research.
不可压缩性躯干出血（NCTH）是创伤中可预防死亡的主要原因。复苏性血管内主动脉球囊阻断术（REBOA）可稳定NCTH，但可能使患者易形成血栓。因此，必须对REBOA联合使用抗纤溶氨甲环酸（TXA）时的凝血风险进行前瞻性评估。利用猪出血模型，研究人员推测REBOA联合TXA会使凝血结果和器官损伤恶化。
32只雄性约克夏猪接受30%血容量的出血，并随机分为溶剂对照组（VC；生理盐水）、VC+REBOA组、TXA组或TXA+REBOA组。在T0时，动物接受10毫升/分钟的组特异性输注（GSI），在T10时接受500毫升全血（WB），然后以13毫升/小时的速度进行第二次GSI，REBOA组在区域1进行球囊阻断。在T40时，REBOA放气，再输注500毫升WB，并继续GSI 3小时。在整个实验过程中测量生理、凝血和炎症参数，并进行死后组织病理学检查。
在T40时REBOA放气后，REBOA组的乳酸水平显著高于非REBOA组，pH值、碳酸氢盐和碱剩余均显著低于非REBOA组。各组在凝血、炎症、代谢或组织病理学参数方面未观察到显著差异。
REBOA联合使用TXA不会导致更有害的凝血结果。所有显著变化都是REBOA缺血的预期结果，而非TXA治疗所致。这表明，两种出血控制方法均可安全治疗NCTH，且不会加剧凝血结果。
不适用——基础动物研究。
