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Open Access 01-12-2021 | Polytrauma | Research

Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model

Authors: Sascha Halvachizadeh, Ladislav Mica, Yannik Kalbas, Miriam Lipiski, Marko Canic, Michel Teuben, Nikola Cesarovic, Zoran Rancic, Paolo Cinelli, Valentin Neuhaus, Hans- Christoph Pape, Roman Pfeifer

Published in: European Journal of Medical Research | Issue 1/2021

Abstract

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. Furthermore, 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.

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Title: Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model
Authors: Sascha Halvachizadeh
Ladislav Mica
Yannik Kalbas
Miriam Lipiski
Marko Canic
Michel Teuben
Nikola Cesarovic
Zoran Rancic
Paolo Cinelli
Valentin Neuhaus
Hans- Christoph Pape
Roman Pfeifer
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Polytrauma
Shock
Shock
Polytrauma
Published in: European Journal of Medical Research / Issue 1/2021
Electronic ISSN: 2047-783X
DOI: https://doi.org/10.1186/s40001-021-00485-y

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Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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