Extended resuscitative endovascular balloon occlusion of the aorta (REBOA)-induced type 2 myocardial ischemia: a time-dependent penalty

Trauma Surgery & Acute Care Open
Philip J WasicekJonathan J Morrison

Abstract

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) increases cardiac-afterload and is used for patients in hemorrhagic shock. The cardiac tolerance of prolonged afterload augmentation in this context is unknown. The aim of this study is to quantify cardiac injury, if any, following 2, 3 and 4 hours of REBOA. Anesthetized swine (70-90 kg) underwent a 40% controlled hemorrhage, followed by supraceliac resuscitative endovascular balloon occlusion of the aorta (REBOA) for 2 (n=5), 3 (n=5), and 4 hours (n=5). High-fidelity arterial wave form data were collected, and signal processing techniques were used to extract key inflection points. The adjusted augmentation index (AIx@75; augmentation pressure/pulse pressure, normalized for heart rate) was derived for use as a measure of aortic compliance (higher ratio = less compliance). Endpoints consisted of electrocardiographic, biochemical, and histologic markers of myocardial injury/ischemia. Regression modeling was used to assess the trend against time. All animals tolerated instrumentation, hemorrhage, and REBOA. The mean (±SD) systolic blood pressure (mm Hg) increased from 65±11 to 212±39 (p<0.001) during REBOA. The AIx@75 was significantly higher during REBOA than base...Continue Reading

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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
Feb 19, 2020·The Journal of Trauma and Acute Care Surgery·Kaeli J YamashiroJacob T Stephenson
May 31, 2019·The Journal of Trauma and Acute Care Surgery·Carl A BeyerMichael Austin Johnson

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Software Mentioned

Excel
MATLAB
GraphPad Prism
REBOA

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