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Review
. 2016 Sep;46(3 Suppl 1):12-9.
doi: 10.1097/SHK.0000000000000641.

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Rachel M Russo  1 , Lucas P Neff, Michael Austin Johnson, Timothy K Williams
Affiliations
Review

Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage

Rachel M Russo et al. Shock. 2016 Sep.

Abstract

Management of non-compressible torso hemorrhage (NCTH) remains a challenge despite continued advancements in trauma resuscitation. Resuscitative thoracotomy with aortic cross-clamping and recent advances in endovascular aortic occlusion, including resuscitative endovascular occlusion of the aorta, have finite durations of therapy due to the inherent physiologic stressors that accompany complete occlusion. Here, we attempt to illuminate the current state of aortic occlusion for trauma resuscitation including explanation of the deleterious consequences of complete occlusion, potential methods and limitations of existing technology to overcome these consequences, and a description of innovative methods to improve the resuscitation of NCTH. By explaining the complexity and potential deleterious effects of resuscitation augmented with aortic occlusion, our goal is to provide practitioners with a real-world perspective on current endovascular technology and to encourage the continued innovation required to overcome existing obstacles.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1
Figure 1
Zones of aortic occlusion. Zone I includes the descending thoracic aorta from the left subclavian artery to the level of the celiac artery. Zone 1 is the most common location of REBOA occlusion. Zone II extends from the celiac artery to the lowest renal artery. Occlusion in Zone II is rarely advisable. Zone III extends from the lowest renal artery to the aortic bifurcation. Zone III occlusion is suitable for pelvic and junctional hemorrhage of the lower extremities.
Figure 2
Figure 2
Aortic blood pressure and blood flow variation in response to inflation volume for an endoluminal aortic occlusion balloon. This graph depicts the relationship between CODA (Cook Medical, Bloomington, IN) balloon volume, mean arterial pressure in the proximal thoracic aorta, and distal aortic blood flow during 5 minutes of complete resuscitative endovascular balloon aortic occlusion followed by 5 minutes of incremental balloon deflation in a euvolemic Yorkshire-cross swine. MAP: Mean Arterial Pressure; REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta.
Figure 3
Figure 3
Endovascular Variable Aortic Control devices would rely on integrated physiologic monitoring equipment to sense the patient’s hemodynamic changes and response with real-time, dynamic regulation of distal aortic blood flow.
See this image and copyright information in PMC

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