Quantifying the Cardiovascular Physiology of REBOA and Partial REBOA: How REBOA Facilitates Resuscitation but Also Strains the Left Ventricle

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used as an approach to aortic occlusion. This can provide complete or partial and thereby known augment afterload relative extent Despite increasing use this tool, little cardiovascular physiology has been quantified across clinically relevant REBOA transitions: placement occlusive REBOA, then transition partially lastly, removal. The goal study pressure-volume loop analysis direct left coronary artery blood flow measurements capture these transitions in a swine model hemorrhagic shock elucidate underlying physiologic mechanism clinical use. Swine underwent complex surgical vascular access instrumentation real-time ventricular loops directly measure (Figure 1). Animals were hemorrhaged 45 mmHg with subsequent fully followed by while data captured. A full methodological protocol published: https://doi.org/10.21203/rs.3.pex-1646/v1. Five male (mean weight, 53.6 ± 3.6 kg). Hemorrhagic was induced maintained reduction stroke work (baseline: 3.1 L × vs shock: 1.2 mmHg; P < .01) average end systolic pressure (109.8 59.6 = .02). augmented volume relationship. Stroke evolved (1.2 4.3 mmHgL; .01). End elastance from baseline (1.01 0.39 4.50 mL/mmHg; remained elevated (3.22 mL/mmHg) 2). Percent time antegrade decreased during (94% 71.8%; rescued but also increased peak compared (271 93 mL/min; total flow, even beyond (peak: 2136 baseline: 424 No state diastolic maintains relationship, increases afterload, augmenting relationship ventricle contractility REBOA. alters reversing shock-induced retrograde therefore flow. modulation underlies its resuscitative capability may drive injury. Partial resuscitation balances improvement against undue strain.Fig 2End (Ees; slope relationship) evolution periods. *P .003; **P .048; ***P .01; ****P .015.View Large Image Figure ViewerDownload Hi-res image Download (PPT)