Abstract
Introduction
One of the advantages of partial Resuscitative Endovascular Balloon Occlusion of the
Aorta (pREBOA) compared to the original model is the mitigation of reperfusion injury.
The safety and efficacy of pREBOA have not been demonstrated in the setting of aeromedical
evacuation. We hypothesized that the pREBOA would result in less ischemia-reperfusion
injury after altitude exposure.
Methods
Twenty-four swine underwent femur fracture with hemorrhage for 20 min, followed by
resuscitative endovascular balloon occlusion of the aorta (REBOA) deployment to Zone
1 and were randomized to pREBOA-PRO (Prytime Medical Devices Inc) full inflation,
partial inflation, or sham inflation and then an altitude exposure of ground level
or 8000 ft for 15 min. The primary endpoint was to examine if the balloon functioned
at altitude. Our secondary endpoint was investigating evidence of ischemia-reperfusion
by hemodynamic instability, electrolyte derangements, and acidosis. Comparisons were
made by ANOVA.
Results
After deflation, the partially inflated group maintained a higher mean arterial pressure
(MAP) compared to fully inflated group (P = 0.026). Full REBOA pigs were more tachycardic compared to sham pREBOA at ground
(P < 0.001) and this was exacerbated at altitude (P < 0.001). Full REBOA pigs were more acidotic than sham and pREBOA at ground pigs
(P = 0.0006 and P = 0.0002, respectively). Altitude increased the acidosis in full REBOA pigs, resulting
in a greater base deficit (P < 0.0001), lactate (P < 0.0001), and IL-6 (P = 0.006).
Conclusions
PREBOA resulted in less severe ischemia-reperfusion injury at both altitude and ground,
while full balloon inflation at altitude exacerbated acidosis and ischemia-reperfusion
injury. Efforts should therefore be made to utilize partial balloon occlusion when
employing the REBOA catheter.
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Article info
Publication history
Published online: November 17, 2022
Accepted:
October 18,
2022
Received in revised form:
October 4,
2022
Received:
June 7,
2022
Identification
Copyright
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