Esmolol reduces myocardial injury induced by resuscitative endovascular balloon occlusion of the aorta (REBOA) in a porcine model of hemorrhagic shock

Abstract Purpose Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes myocardial injury from increased aortic afterload and supraphysiologic cardiac output. However, pharmacologic methods to attenuate high cardiac output and reduce myocardial injury have not been explored. We hypothesized that the use of esmolol during REBOA would reduce myocardial injury. Methods Ten pigs were anesthetized and instrumented. Following 25% total blood volume hemorrhage, animals underwent 45 minutes of supraceliac (zone 1) REBOA with or without titration of esmolol to maintain heart rate between 80-100 beats per minute. Following the REBOA interventions, animals underwent 275 minutes of standardized critical care. Results During REBOA, heart rate was significantly lower in the esmolol group compared to control animals (100 [88 - 112] vs 193 [172 - 203] beats/minute, respectively, p 3 - 3 ] and 0 [0 – 0], p = 0.009, respectively). Conclusion In our porcine model of hemorrhagic shock, zone 1 REBOA was associated with myocardial injury. Pharmacologic heart rate titration with esmolol during occlusion may mitigate the deleterious effects of REBOA on the heart.