Novel Focal Abdominal Cavity Cooling REBOA Strategy for the Treatment of Noncompressible Torso Hemorrhage
Abstract
Uncontrolled bleeding from major blood vessel or major solid organ injury is a common cause of death in both civilian and military trauma settings. Hemorrhage in the torso (chest and abdomen) is typically not controllable by external compression. For these non-compressible torso hemorrhage (NCTH) injuries, the placement and inflation of a balloon in the aorta (the main artery in the body that carries oxygenated blood away from the heart) temporarily stops bleeding by occluding the vessel above the injured area. This technique to control hemorrhage is called Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Swine studies have demonstrated that REBOA is effective in temporarily controlling life-threatening bleeding to allow time for targeted hemorrhage control. Aortic occlusion, while effective, leaves large portions of the body without vital blood flow (ischemia) for significant periods of time; this ischemic interval and the reintroduction of blood flow causes the release of numerous cellular toxic waste products further worsening traumatic injuries. REBOA therapy is limited not only by the sustained traumatic injuries but by the organ ischemia followed by the reperfusion injury (ischemia-reperfusion injury or IRI) that results from its use. Both whole body hypothermia or HT and local organ tissue cooling are effective means of protecting vital organs from IRI. Rendering organs hypothermic to complex surgical procedures is frequently used in cardiothoracic and transplant surgery to preserve organ function while mitigating IRI. There are major limitations with current implementation of HT therapies especially in the setting of trauma. HT therapies currently require over an hour to attain therapeutic body temperatures and whole body HT is associated with heart, lung, kidney, and bleeding complications. To overcome the potentially fatal complications of REBOA, IRI, and whole body HT, we have developed a Focal Abdominal Cooling (FAC) device to mitigate associated complications. FAC in rats has shown a significant survival advantages in the treatment of NCTH with REBOA. The concomitant use of FAC and REBOA during evacuation of military or other casualties in a helicopter or airplane (Medevac aircraft) could significantly expand the therapeutic window for the management of NCTH injuries in injured far-forward personnel. FAC has numerous potential civilian applications with regard to the prehospital transport of critically ill patients as well as the use in elective cardiovascular and transplant surgery. Focal abdominal cooling carries the potential to supplant current methods of therapeutic hypothermia. Using a swine model to validate the dramatic mortality prevention observed in the rat model is a necessary step before testing this novel FAC cooling + REBOA strategy in humans. The first aim of this proposal is to carry out initial investigation of the application of FAC + REBOA using a lethal swine NCTH model. The second and third aims are to identify the best conditions for maximal extending the viable REBOA deployment duration in both rat and swine lethal NCTH models. In summary, both REBOA and therapeutic HT are among the best measures for managing military NCTH, but both have potentially fatal complications. To overcome these obstacles, we propose to use the newly invented FAC cooling device, together with REBOA, to treat NCTH patients. This novel FAC + REBOA strategy offers the best opportunity protecting military members from NCTH, because it stops bleeding, prioritizes warm circulation to the brain and heart, and protects abdominal organs. Therefore, if the research aims are attained, we will have demonstrated a novel and effective strategy to prolong out-of-hospital survivable duration for NCTH patients in the prolonged field care environment, and a new portable technology to prevent organ failure and ischemia-reperfusion injury.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810306
Entities
People
- Bingren Hu
Organizations
- United States Army
- University of Maryland, Baltimore