Aortic Balloon Occlusion is Effective in Controlling Pelvic Hemorrhage

Abstract

Background: The objective of this study was to evaluate the efficacy of resuscitative endovascular aortic balloon occlusion (REBOA) of the distal aorta in a porcine model of pelvic hemorrhage. Methods: Swine were entered into three phases of study: injury (iliac artery), hemorrhage (45 s), and intervention (180 min). Three groups were studied: no intervention (NI, n = 7), a kaolin-impregnated gauze (Combat Gauze) (CG, n = 7), or REBOA (n = 7). The protocol was repeated with a dilutional coagulopathy (CG-C, n = 7, and REBOA-C, n = 7). Measures of physiology, rates of hemorrhage, and mortality were recorded. Results: Rate of hemorrhage was greatest in the NI group, followed by the REBOA and CG groups (822 +/- 415 mL/min versus 11 +/- 13 and 0.2 +/- 0.4 mL/min respectively; P < 0.001). MAP following intervention (at 15 min) was the same in the CG and REBOA groups and higher than in the NI group (70 +/- 4 and 70 +/- 11 mm Hg versus 5 +/- 13 mm Hg respectively; P < 0.001). There was 100% mortality in the NI group, with no deaths in the CG or REBOA group. In the setting of coagulopathy, the rate of bleeding was higher in the CG-C versus the REBOA-C group (229 +/- 295 mL/min versus 20 +/- 7 mL/min, P = 0.085). MAP following intervention (15 min) was higher in the REBOA-C than the CG-C group (71 +/- 12 mm Hg versus 28 +/- 31 mm Hg; P = 0.005). There were 5 deaths (71.4%) in the CG-C group, but none in the REBOA-C group (P = 0.010). Conclusion: Balloon occlusion of the aorta is an effective method to control pelvic arterial hemorrhage. This technique should be further developed as an adjunct to manage noncompressible pelvic hemorrhage.

Open PDF

Document Details

Document Type
Technical Report
Publication Date
May 08, 2012
Accession Number
ADA616881

Entities

People

  • Carole Villamaria
  • Daniel J. Scott
  • Jerry R. Spencer
  • Jonathan Morrison
  • Kaylyn A. Saches
  • Nickolay P. Markov
  • Thomas J. Percival
  • Todd E.

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Aneurysm
  • Arteries
  • Blood
  • Cardiovascular Diseases
  • Cardiovascular Physiological Phenomena
  • Cardiovascular System
  • Hemorrhage
  • Hemorrhagic Shock
  • Improvised Explosive Devices
  • Vascular System Injuries
  • Veins

Fields of Study

  • Medicine

Readers

  • Trauma Surgery or Emergency Medicine.