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. 2023 Apr 10;11(1):18.
doi: 10.1186/s40635-023-00502-w.

A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury

Anna Stene Hurtsén  1   2   3 , David T McGreevy  4   5 , Christina Karlsson  6 , Claes G Frostell  7 , Tal M Hörer  4   8 , Kristofer F Nilsson  4   5
Affiliations

A randomized porcine study of hemorrhagic shock comparing end-tidal carbon dioxide targeted and proximal systolic blood pressure targeted partial resuscitative endovascular balloon occlusion of the aorta in the mitigation of metabolic injury

Anna Stene Hurtsén et al. Intensive Care Med Exp. .

Abstract

Background: The definition of partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is not yet determined and clinical markers of the degree of occlusion, metabolic effects and end-organ injury that are clinically monitored in real time are lacking. The aim of the study was to test the hypothesis that end-tidal carbon dioxide (ETCO2) targeted pREBOA causes less metabolic disturbance compared to proximal systolic blood pressure (SBP) targeted pREBOA in a porcine model of hemorrhagic shock.

Materials and methods: Twenty anesthetized pigs (26-35 kg) were randomized to 45 min of either ETCO2 targeted pREBOA (pREBOAETCO2, ETCO2 90-110% of values before start of occlusion, n = 10) or proximal SBP targeted pREBOA (pREBOASBP, SBP 80-100 mmHg, n = 10), during controlled grade IV hemorrhagic shock. Autotransfusion and reperfusion over 3 h followed. Hemodynamic and respiratory parameters, blood samples and jejunal specimens were analyzed.

Results: ETCO2 was significantly higher in the pREBOAETCO2 group during the occlusion compared to the pREBOASBP group, whereas SBP, femoral arterial mean pressure and abdominal aortic blood flow were similar. During reperfusion, arterial and mesenteric lactate, plasma creatinine and plasma troponin concentrations were higher in the pREBOASBP group.

Conclusions: In a porcine model of hemorrhagic shock, ETCO2 targeted pREBOA caused less metabolic disturbance and end-organ damage compared to proximal SBP targeted pREBOA, with no disadvantageous hemodynamic impact. End-tidal CO2 should be investigated in clinical studies as a complementary clinical tool for mitigating ischemic-reperfusion injury when using pREBOA.

Keywords: Balloon occlusion; Carbon dioxide, Metabolism; Chock, hemorrhagic; Ischemia–reperfusion injury.

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Conflict of interest statement

No conflicts of interest related to the subject are present.

Figures

Fig. 1
Fig. 1
Experimental protocol of partial endovascular balloon occlusion of the aorta (pREBOA) targeted by end-tidal carbon dioxide (pREBOAETCO2, n = 10) and proximal systolic blood pressure (pREBOASBP, n = 10) in anesthetized, mechanically ventilated pigs. Each arrowhead indicates a measurement point
Fig. 2
Fig. 2
End-tidal carbon dioxide (ETCO2, A), systemic blood pressure (SBP, B), abdominal aortic blood flow (ABF, C) and femoral arterial mean pressure (FMP, D) in anesthetized, mechanically ventilated pigs undergoing hemorrhage (H), intervention (I) using either end-tidal carbon dioxide (ETCO2) targeted partial resuscitative endovascular balloon occlusion of the aorta (pREBOA, pREBOAETCO2, n = 10) and proximal systolic blood pressure targeted pREBOA (pREBOASBP, n = 10) and subsequent reperfusion (R). a Denotes statistical difference between the groups at a given timepoint. Data are means (95% confidence interval). The dotted line represents baseline
Fig. 3
Fig. 3
Arterial and mesenteric venous pH (A, B) and pCO2 (C, D) in anesthetized, mechanically ventilated pigs undergoing hemorrhage (H), intervention (I) using either end-tidal carbon dioxide (ETCO2) targeted partial resuscitative endovascular balloon occlusion of the aorta (pREBOA, pREBOAETCO2, n = 10) and proximal systolic blood pressure targeted pREBOA (pREBOASBP, n = 10) and subsequent reperfusion (R). a Denotes statistical difference between the groups at given timepoint. Data are means (95% confidence interval). The dotted line represents baseline
Fig. 4
Fig. 4
Arterial and mesenteric venous lactate (A, B) and potassium (K; C, D) concentrations in anesthetized, mechanically ventilated pigs undergoing hemorrhage (H), intervention (I) by end-tidal carbon dioxide (ETCO2) targeted partial resuscitative endovascular balloon occlusion of the aorta (pREBOA, pREBOAETCO2, n = 10) and proximal systolic blood pressure targeted pREBOA (pREBOASBP, n = 10) and subsequent reperfusion (R). a Denotes statistical difference between the groups at given timepoint. Data are means (95% confidence interval). The dotted line represents baseline
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