Endovascular variable aortic control (EVAC) versus resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhage and ischemia reperfusion injury

The Journal of Trauma and Acute Care Surgery
Timothy K WilliamsM Austin Johnson

Abstract

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is effective at limiting hemorrhage from noncompressible sources and restoring but causes progressive distal ischemia, supraphysiologic pressures, and increased cardiac afterload. Endovascular variable aortic control (EVAC) addresses these limitations, while still controlling hemorrhage. Previous work demonstrated improved outcomes following a 90-minute intervention period in an uncontrolled hemorrhage model. The present study compares automated EVAC to REBOA over an occlusion period reflective of contemporary REBOA usage. Following instrumentation, 12 Yorkshire-cross swine underwent controlled 25% hemorrhage, a 45-minute intervention period of EVAC or REBOA, and subsequent resuscitation with whole blood and critical care for the remainder of a 6-hour experiment. Hemodynamics were acquired continuously, and laboratory parameters were assessed at routine intervals. Tissue was collected for histopathologic analysis. No differences were seen in baseline parameters. During intervention, EVAC resulted in more physiologic proximal pressure augmentation compared with REBOA (101 vs. 129 mm Hg; 95% confidence interval [CI], 105-151 mm Hg; p = 0.04). During critical care, ...Continue Reading

References

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Sep 13, 2011·The Journal of Trauma·David S PluradDemetrios Demetriades
Oct 4, 2013·The Journal of Trauma and Acute Care Surgery·Megan L BrennerTodd E Rasmussen
Dec 17, 2015·The Journal of Trauma and Acute Care Surgery·Ian J StewartKevin K Chung
Apr 14, 2016·The Journal of Trauma and Acute Care Surgery·Timothy Keith WilliamsTodd E Rasmussen
May 4, 2016·Journal of the American College of Surgeons·Rachel M RussoTimothy K Williams
May 14, 2016·Shock·Rachel M RussoTimothy K Williams
Oct 22, 2016·The Journal of Trauma and Acute Care Surgery·M Austin JohnsonUNKNOWN EVAC Study Group
Feb 7, 2017·The Journal of Trauma and Acute Care Surgery·Timothy K WilliamsTodd E Rasmussen
Jul 3, 2018·The Journal of Trauma and Acute Care Surgery·Emily M TibbitsM Austin Johnson

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Citations

Oct 3, 2019·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Carl A BeyerMichael A Johnson
May 31, 2019·The Journal of Trauma and Acute Care Surgery·Carl A BeyerMichael Austin Johnson
Feb 19, 2020·The Journal of Trauma and Acute Care Surgery·Kaeli J YamashiroJacob T Stephenson
Nov 7, 2019·The Journal of Trauma and Acute Care Surgery·M Austin JohnsonTimothy K Williams
Aug 3, 2020·The Journal of Trauma and Acute Care Surgery·Catherine GoBryan W Tillman
Aug 30, 2019·The Journal of Trauma and Acute Care Surgery·Timothy Keith WilliamsM Austin Johnson
Apr 3, 2021·The Journal of Trauma and Acute Care Surgery·Sarah C StokesRachel M Russo

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