Lower extremity cooling reduces ischemia-reperfusion injury following Zone 3 REBOA in a porcine hemorrhage model

The Journal of Trauma and Acute Care Surgery
Meryl A SimonTimothy K Williams

Abstract

New strategies to mitigate ischemia during REBOA and to prolong its maximal duration are needed. We hypothesized that simple external cooling of the hind limbs would decrease ischemia-reperfusion injury following prolonged Zone 3 REBOA. Twelve swine were anesthetized, instrumented, splenectomized, and then underwent 15% total blood volume hemorrhage. Animals were randomized to hypothermia or control followed by 4 hours of Zone 3 REBOA, resuscitation with shed blood, and 3 hours of critical care. Physiologic parameters were continuously recorded, and laboratory specimens were obtained at regular intervals. Baseline and end-of-study muscle biopsies were obtained for histologic analysis. There were no significant differences between groups at baseline or after hemorrhage. Maximum creatine kinase was significantly lower in the hypothermia group compared with the normothermia group (median [interquartile range] = 3,445 U/mL [3,380-4,402 U/mL] vs. 22,544 U/mL [17,030-24,981 U/mL]; p < 0.01). Maximum serum myoglobin was also significantly lower in the hypothermia group (1,792 ng/mL [1,250-3,668 ng/mL] vs. 21,186 ng/mL [14,181-24,779 ng/mL]; p < 0.01). Fascial compartment pressures were significantly lower during critical care in the h...Continue Reading

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Citations

Mar 7, 2020·Nursing·Marilynn Kyritsis Bartley
May 21, 2020·Acute Medicine & Surgery·Hiromichi NaitoAtsunori Nakao
Feb 20, 2020·Military Medicine·Harris W KashtanM Austin Johnson
Jan 8, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Marianne A ThrailkillAndriy I Batchinsky
Apr 3, 2021·The Journal of Trauma and Acute Care Surgery·Sarah C StokesRachel M Russo

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