Document Detail


Endovascular balloon occlusion of the aorta is superior to resuscitative thoracotomy with aortic clamping in a porcine model of hemorrhagic shock.
MedLine Citation:
PMID:  21878225     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Noncompressible torso hemorrhage is the leading cause of potentially preventable death on the modern battlefield. The objective of this study is to characterize resuscitative aortic balloon occlusion (BO) compared to thoracotomy with aortic clamping in a model of hemorrhagic shock.
METHODS: A total of 18 swine (3 groups; 6 animals/group) were used in this study. Swine in class IV shock underwent no aortic occlusion (NO), thoracotomy and clamp occlusion (CO), or endovascular BO. Animals in the NO group underwent direct placement of a temporary vascular shunt (TVS) at the injury site, whereas animals in the CO and BO groups underwent aortic occlusion before TVS placement. Hemodynamic and physiologic measures were collected.
RESULTS: The central aortic pressure, carotid blood flow and brain oxygenation as measured by oximetry increased in the CO and BO groups compared to the NO group (P < .05). During resuscitation, the BO group was less acidotic than the CO group (pH,7.35 vs 7.24; P < .05) with a lower serum lactate level (4.27 vs 6.55; P < .05) and pCO2 level (43.5 vs 49.9; P < .05). During resuscitation, the BO group required less fluid (667 mL vs 2,166 mL; P < .05) and norepinephrine (0 mcg vs 52.1 mcg; P < .05) than the CO group.
CONCLUSION: Resuscitative aortic BO increases central perfusion pressures with less physiologic disturbance than thoracotomy with aortic clamping in a model of hemorrhagic shock. Endovascular BO of the aorta should be explored further as an option in the management of noncompressible torso hemorrhage.
Authors:
Joseph M White; Jeremy W Cannon; Adam Stannard; Nickolay P Markov; Jerry R Spencer; Todd E Rasmussen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  150     ISSN:  1532-7361     ISO Abbreviation:  Surgery     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-08-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  400-9     Citation Subset:  AIM; IM    
Copyright Information:
Published by Mosby, Inc.
Affiliation:
Wilford Hall United States Air Force Medical Center, Lackland Air Force Base, San Antonio, TX.
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