Mitigating Complications of Resucitative Endovascular Balloon Occlusion of the Aorta by Use of Partial Occlusion and Simultaneous Administration of Blood Products Distal to Occlusion Site: An Animal Stud

Problem: Traumatic hemorrhagic shock is one of the leading causes of death worldwide. It may require enormous resources to treat; patients present with a high degree of variance and may be critically ill when they first arrive. Advances have been made in identification of acute bleeding by means of the FAST exam and increasingly accurate CT scans. Massive transfusion protocol has aided in maintaining blood volume in hemorrhaging patients, but does nothing to achieve definitive hemostasis. Invasive procedures such as open thoracotomy have often been used as a last-ditch effort, but before the decision to undergo such an extreme procedure, it is often too late, particularly in blunt trauma. Within the last several years resuscitative endovascular balloon occlusion of the aorta (REBOA) has surfaced as a minimally invasive and potentially lifesaving procedure in the setting of hemorrhagic shock. Purpose: REBOA is not yet a perfected procedure; occlusion of the aorta has serious detrimental side effects. This thesis will investigate mitigating the known complications of REBOA by partial inflation with direct administration of blood product distal to the site of occlusion. Research Question: Does using partial REBOA while simultaneously providing blood products downstream of the occlusion site increase the window of time before potentially harmful ischemic events occur distal to the occlusion, compared to partial occlusion and complete occlusion without the use of blood products. Methods: This will be a live animal study comparing partial occlusion with administration of blood products, parital occlusion without administration of blood products, and complete occlusion without administration of blood products. Outcomes: There still is much research that needs to be done on REBOA to minimize complications and further clarify exactly when it should be used.