Resuscitative Endovascular Balloon Occlusion Of The Aorta (REBOA) In A Pediatric Swine Model: Is 60 Minutes Too Long?
Kaeli Yamashiro1, Laura Galganski2, Connor Caples1, J. Kevin Grayson3, Marguerite Spruce1, Carl Beyer1, M. Austin Johnson2, Andrew Wishy1, A. Francois Trappey1, Jacob Stephenson1
1David Grant USAF Medical Center, Travis Air Force Base and University of California, Davis, Sacramento, CA;2University of California, Davis, Sacramento, CA;3David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA
BACKGROUND: Zone 1 resuscitative endovascular balloon occlusion of the aorta (REBOA) is indicated in adults with non-compressible torso hemorrhage for less than 60 minutes. However, in children, the tolerable duration is unknown. We designed a pediatric swine controlled hemorrhage model to evaluate the physiologic effects of 30 and 60 minutes of REBOA.
METHODS: Pediatric swine weighing 20-30kg underwent splenectomy, a controlled 60% total blood volume hemorrhage over 30 minutes, followed by Zone 1 REBOA for 60 minutes (60R) or 30 minutes (30R). Swine were resuscitated with shed blood and received critical care for 240 minutes.
RESULTS: Compared to baseline, end creatinine and creatinine kinase were elevated in 60R swine (n=5, 0.97 vs 1.7mg/dL, p<0.01 and 335.4 vs 961U/L, p<0.001, respectively), but not 30R swine (n=3, 0.91 vs 1.2mg/dL, p=0.06 and 423.7 vs 769.5U/L, p=0.15, respectively). During critical care, the 30R swine's pH, HCO3, base excess and lactate no longer differed from baseline, while at the end of critical care, the 60R swine continued to differ from baseline and were worsening (7.4 vs 7.2, p<0.001, 30.4 vs 18.4mmol/L, p<0.0001, 5.6 vs -8.5mmol/L, p<0.0001, 2.4 vs 5.7mmol/L, p<0.001, respectively). There was no difference in survival in the 60R swine (60%) and 30R swine (66.7%), p=0.85.
CONCLUSION: The physiologic effects of Zone 1 REBOA for 30 minutes mostly resolve within 3 hours of balloon deflation, whereas the effects of 60 minutes persist and worsen after 4 hours of critical care. Sixty minutes of Zone 1 REBOA may be too long in children.
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