Targeted Regional Optimization in Action: Dose-dependent End-organ Ischemic Injury with Partial Aortic Occlusion in the Setting of Ongoing Liver Hemorrhage

Targeted regional optimization (TRO) describes partial resuscitative endovascular balloon occlusion of the aorta strategy that allows for controlled distal perfusion to balance hemostasis and tissue perfusion. This study characterized hemodynamics at specific targeted distal flow rates in a swine mo...

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Bibliographic Details
Published in:Shock (Augusta, Ga.) Ga.), 2022-05, Vol.57 (5), p.732-739
Main Authors: Ronaldi, Alley E, Lauria, Alexis L, Paterson, Jeanette E, Kersey, Alexander J, Leung, Lai Yee, Burmeister, David M, Baer, David G, White, Paul W, Rasmussen, Todd E, White, Joseph M
Format: Article
Language:English
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Summary:Targeted regional optimization (TRO) describes partial resuscitative endovascular balloon occlusion of the aorta strategy that allows for controlled distal perfusion to balance hemostasis and tissue perfusion. This study characterized hemodynamics at specific targeted distal flow rates in a swine model of uncontrolled hemorrhage to determine if precise TRO by volume was possible. Anesthetized swine were subjected to liver laceration and randomized into TRO at distal flows of 300 mL/min (n = 8), 500 mL/min (n = 8), or 700 mL/min (n = 8). After 90 min, the animals received damage control packing and were monitored for 6 h. Hemodynamic parameters were measured continuously, and hematology and serologic labs obtained at predetermined intervals. During TRO, the average percent deviation from the targeted flow was lower than 15.9% for all cohorts. Average renal flow rates were significantly different across all cohorts during TRO phase (P 
ISSN:1073-2322
1540-0514
DOI:10.1097/SHK.0000000000001922