Resuscitative endovascular balloon occlusion of the aorta (REBOA) minimal dataset

Introduction Resuscitative endovascular balloon occlusion of the aorta
(REBOA) may be used in severely injured patients with uncontrollable
bleeding. However, zone dependent effects of REBOA are rarely described.
We compared the short-term zone- and organ-specific microcirculatory
changes in abdominal organs and the extremity during occlusion of the
aorta in a standardized porcine model. Methods Male pigs were placed under
general anesthesia, for median laparotomy to expose intra-abdominal
organs. REBOA placement occurred in Zone 1 (from origin left subclavian
artery to celiac trunk), Zone 2 (between the coeliac trunk and most caudal
renal artery) and Zone 3 (distal most caudal renal artery to aortic
bifurcation). Local microcirculation of the intra-abdominal organs were
measured at the stomach, colon, small intestine, liver, and kidneys.
Further, the right medial vastus muscle was included for assessment.
Microcirculation was measured using oxygen-to-see device (arbitrary units,
A.U). Invasive blood pressure measurements were recorded in the carotid
and femoral artery (ipsilateral). Ischemia/Reperfusion (I/R)-time was 10
min with complete occlusion. Results At baseline, microcirculation of
intra-abdominal organs differed significantly (p < 0.001), the
highest flow was in the kidneys (208.3 ± 32.9 A.U), followed by the colon
(205.7 ± 36.2 A.U.). At occlusion in Zone 1, all truncal organs showed
significant decreases (p < 0.001) in microcirculation, by 75% at
the colon, and 44% at the stomach. Flow-rate changes at the extremities
were non-significant (n.s). During occlusion in Zone 2, a significant
decrease (p < 0.001) in microcirculation was observed at the colon
(-78%), small intestine (-53%) and kidney (-65%). The microcirculatory
changes at the extremity were n.s. During occlusion in Zone 3, truncal and
extremity microcirculatory changes were n.s. Conclusion All abdominal
organs showed significant changes in microcirculation during REBOA. The
intra-abdominal organs react differently to the same occlusion, whereas
local microcirculation in extremities appeared to be unaffected by
short-time REBOA, regardless of the zone of occlusion.