Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model
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 i...
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doaj-3ad11881951c45988313c711e2e5813c2021-01-24T12:42:05ZengBMCEuropean Journal of Medical Research2047-783X2021-01-012611910.1186/s40001-021-00485-yZone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental modelSascha Halvachizadeh0Ladislav Mica1Yannik Kalbas2Miriam Lipiski3Marko Canic4Michel Teuben5Nikola Cesarovic6Zoran Rancic7Paolo Cinelli8Valentin Neuhaus9Hans- Christoph Pape10Roman Pfeifer11Department of Trauma, University of Zurich, University Hospital ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichDivision of Surgical Research, University Hospital Zurich, University of ZurichDivision of Surgical Research, University Hospital Zurich, University of ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichDivision of Surgical Research, University Hospital Zurich, University of ZurichDepartment of Vascular Surgery, University Hospital ZürichDepartment of Trauma, University of Zurich, University Hospital ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichDepartment of Trauma, University of Zurich, University Hospital ZurichAbstract 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.https://doi.org/10.1186/s40001-021-00485-yREBOAAbdominal organ perfusionShockTraumaResuscitative balloon occlusion of the aortaPolytrauma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
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 |
spellingShingle |
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 Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model European Journal of Medical Research REBOA Abdominal organ perfusion Shock Trauma Resuscitative balloon occlusion of the aorta Polytrauma |
author_facet |
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 |
author_sort |
Sascha Halvachizadeh |
title |
Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model |
title_short |
Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model |
title_full |
Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model |
title_fullStr |
Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model |
title_full_unstemmed |
Zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (REBOA): an experimental model |
title_sort |
zone-dependent acute circulatory changes in abdominal organs and extremities after resuscitative balloon occlusion of the aorta (reboa): an experimental model |
publisher |
BMC |
series |
European Journal of Medical Research |
issn |
2047-783X |
publishDate |
2021-01-01 |
description |
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. |
topic |
REBOA Abdominal organ perfusion Shock Trauma Resuscitative balloon occlusion of the aorta Polytrauma |
url |
https://doi.org/10.1186/s40001-021-00485-y |
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