248: Resuscitative Endovascular Balloon Occlusion of the Aorta Improves Survival in Lethal Hemorrhage

Abstract : Learning Objectives: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) using generic balloon catheters placed into the descending aorta under fluoroscopy has been used to treat hemorrhagic shock in animal models. We tested a new non-image guided 7F ER-REBOA catheter (Pryor Medical Arvada, CO) for its potential to improve survival in a 100% lethal model of hemorrhagic shock. We hypothesized that ER-REBOA, placed without fluoroscopic guidance, improves survival. Methods: Spontaneously breathing, consciously sedated, sexually mature male Sinclair pigs undergone computerized exponential hemorrhage of 65% of their blood volume over 1 hour via an arterial line. Animals were then randomized into groups of 7 animals each including: negative control (NC), no resuscitation; positive control (PC), immediate transfusion of shed blood (TSB); ER30; 30 min of ERREBOA then TSB; ER60, 60 min of ER-REBOA then TSB; ER, 60 min of ERREBOA with TSB after 30 min of REBOA. After balloon deflation, epinephrine was given if mean arterial pressure was under 40 mm Hg. Up to 20 min of mechanical ventilation (FiO2 .21, RR 12, TV 10 ml/kg, ZEEP) was provided if animal suffered respiratory arrest. Animals were monitored for 240 min post-hemorrhage or until death. Survival was assessed via Kaplan-Meier analysis. Balloon placement was verified via post-mortem CT scan and at necropsy. Results: ER-REBOA was placed successfully in 100% of cases without fluoroscopy. Survival in the NC and PC groups was 0 and 71% respectively. Analysis showed significantly higher survival in the ER-REBOA groups: 100% in ER30 and ER60 groups and 86% in ER (p0.001). Epinephrine was given to 4/7 PC animals and to 6/7, 7/7, and 2/7 animals in ER30, ER60, and ER groups respectively. Ventilation support was given to 1/7, 2/7, and 3/7 in the ER30, ER60, and ER groups and to 2/7 in the PC group respectively.