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J Surg Res. 2018 Jun;226:31-39. doi: 10.1016/j.jss.2017.12.039. Epub 2018 Feb 10.

Comparison of zone 3 Resuscitative Endovascular Balloon Occlusion of the Aorta and the Abdominal Aortic and Junctional Tourniquet in a model of junctional hemorrhage in swine.

Author information

1
Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, San Antonio, Texas. Electronic address: jason.m.rall.ctr@mail.mil.
2
San Antonio Uniformed Services Health Education Consortium, JBSA-Fort Sam Houston, San Antonio, Texas.
3
R Adam Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland.
4
Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, San Antonio, Texas; Air Force En Route Care Research Center, U.S. Army Institute of Surgical Research/59th MDW, JBSA-Fort Sam Houston, San Antonio, Texas.

Abstract

BACKGROUND:

Traumatic injuries to the pelvis and high junctional injuries are difficult to treat in the field; however, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the Abdominal Aortic and Junctional Tourniquet (AAJT) constitute two promising treatment modalities. The aim of this study is to use a large animal model of pelvic hemorrhage to compare the survival, hemostatic, hemodynamic, and metabolic profile of both techniques.

METHODS:

Yorkshire swine (n = 10, 70-90 kg) underwent general anesthesia, instrumentation, and surgical isolation of the femoral artery. Uncontrolled hemorrhage was initiated by an arteriotomy. Animals were randomly allocated to either REBOA or AAJT. Following completion of device application, both groups received a 500 mL Hextend bolus. After 1 hour, the injured femoral artery was ligated to simulate definitive hemostasis followed by a second Hextend bolus and device removal. Animals were observed for two more hours. Physiological data were collected throughout the experiments and compared between groups.

RESULTS:

Both techniques achieved 100% hemostasis, and all animals survived the entire experiment except one in the REBOA group. During the hour treatment phase, the AAJT group had a higher mean arterial pressure than the REBOA group (59.9 ± 16.1 versus 44.6 ± 9.8 mm Hg, respectively; P < 0.05). The AAJT-treated group had higher lactate levels than the REBOA-treated group (4.5 ± 2.0 versus 3.2 ± 1.3 mg/dL, respectively; P < 0.05).

CONCLUSIONS:

Despite their mechanistic differences, both techniques achieved a similar hemostatic, hemodynamic, and metabolic profile. Some differences do exist including lactate levels and blood pressure.

KEYWORDS:

AAJT; Abdominal Aortic and Junctional Tourniquet; Hemorrhage; Hemostasis; Noncompressible; Pelvic hemorrhage; REBOA; Resuscitative Balloon Occlusion of the Aorta; Trauma

PMID:
29661286
DOI:
10.1016/j.jss.2017.12.039
[Indexed for MEDLINE]

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