Ischemia - reperfusion (I/R) induced effects during resuscitative balloon occlusion of the aorta (REBOA): How does the Zone of occlusion affect extremities and truncal perfusion?

Objectives Resuscitative endovascular balloon occlusion of the aorta (REBOA) may be used in severely injured patients with uncontrollable bleeding. However, the zone dependent effect of REBOA are sparsely described. We compared zone- and organ-specific circulatory changes of the trunk and the extremity during occlusion of the aorta in a standardized porcine model.

Methods Male pigs general anaesthesia, median laparotomy for intra-abdominal organ exposure. REBOA placement in Zones 3 (distal most distal renal artery to aortic bifurcation), 2 (between coeliac trunc to most caudal renal artery, and 1 (from origin left subclavian artery to coeliac trunc). Local microcirculation of the trunk include:stomach, colon, small intestine, liver, and kidneys; extremity: right medial vastus muscle using oxygen-to-see device (O2C, Lea Inc., Germany, arbitrary units [A.U.]). Invasive blood pressure measurements: carotid artery, femoral artery (ipsilateral). I/R-time 10 minutes with complete occlusion.

Results and Conclusion Baseline: Microcirculation of intra-abdominal organs differed significantly (p < 0.001): Highest flow in the kidneys (208.33 A.U., SD 32.9), followed by colon (205.7 A.U., SD 36.2).

Occlusion zone 1: All truncal organs show a significant decrease of microcirculation (p < 0.001) by at least 75 % at the colon and 44 % at the stomach. Flow-rate changes extremity: n.s.

Occlusion zone 2: Significant decrease of microcirculation for colon (by 78 %), small intestine (53 %), and kidney (65 %) (p < 0.001). Extremities: n.s.

Occlusion zone 3: n.s. for truncal and extremity microcirculatory changes.

All abdominal organs show significant changes in microcirculation during occlusion, whereas the local microcirculation of the extremity seems not to be affected by short-time REBOA regardless the zone of occlusion.

Stichwörter REBOA, microcirculation, Organ circulation

Publication History

Article published online:
15 October 2020