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Purpose <p>To evaluate the future efficacy and prolonged availability of double-balloon resuscitative endovascular balloon occlusion of the aorta (DB-REBOA) to determine whether bypassing upstream blood at the occlusion site improves survival in a porcine hemorrhagic shock model.</p> Methods <p>Twenty-five pigs (approximately 40&#xa0;kg, estimated circulating blood volume 25%) were subjected to hemorrhagic shock by controlled phlebotomy. Animals were treated with standard REBOA (control, <i>n</i> = 12), internal shunt DB-REBOA (internal shunt, <i>n</i> = 4; an intraluminal conduit was set parallel to the DBREBOA in the aorta), or external shunt DB-REBOA (external shunt, <i>n</i> = 9; upstream blood from the occlusion site was shunted by connecting the internal carotid and femoral arteries with a pressure-resistant tube). Zone 1 aortic occlusion was maintained for 90&#xa0;min, followed by balloon deflation. Survival, systolic blood pressure, and serum lactate levels were analyzed.</p> Results <p>Ten of 12 control animals developed cardiac arrest shortly after balloon deflation. All animals in the internal shunt group survived, whereas 5 of 9 animals in the external shunt group experienced cardiac arrest. Internal shunt DB-REBOA maintained stable systolic BP during prolonged occlusion, resulting in significantly lower serum lactate levels at 90&#xa0;min compared to controls. External shunt DB-REBOA resulted in unstable hemodynamics and no significant metabolic benefit.</p> Conclusion <p>Preservation of distal perfusion using an internal shunt markedly improved survival and physiological stability during prolonged Zone 1 aortic occlusion. This strategy may extend the safe duration of REBOA when definitive hemorrhage control is delayed. The development of a new REBOA catheter for this purpose is anticipated.</p>

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A study on prolonged use of resuscitative endovascular balloon of the aorta (REBOA) with shunt flow in a porcine hemorrhagic shock model

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月10日

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  • Nobuaki Kiriu,
  • Daizoh Saitoh,
  • Koji Yamamura,
  • Ruka Sasa,
  • Tetsuro Kiyozumi,
  • Satoshi Tomura

摘要

Purpose

To evaluate the future efficacy and prolonged availability of double-balloon resuscitative endovascular balloon occlusion of the aorta (DB-REBOA) to determine whether bypassing upstream blood at the occlusion site improves survival in a porcine hemorrhagic shock model.

Methods

Twenty-five pigs (approximately 40 kg, estimated circulating blood volume 25%) were subjected to hemorrhagic shock by controlled phlebotomy. Animals were treated with standard REBOA (control, n = 12), internal shunt DB-REBOA (internal shunt, n = 4; an intraluminal conduit was set parallel to the DBREBOA in the aorta), or external shunt DB-REBOA (external shunt, n = 9; upstream blood from the occlusion site was shunted by connecting the internal carotid and femoral arteries with a pressure-resistant tube). Zone 1 aortic occlusion was maintained for 90 min, followed by balloon deflation. Survival, systolic blood pressure, and serum lactate levels were analyzed.

Results

Ten of 12 control animals developed cardiac arrest shortly after balloon deflation. All animals in the internal shunt group survived, whereas 5 of 9 animals in the external shunt group experienced cardiac arrest. Internal shunt DB-REBOA maintained stable systolic BP during prolonged occlusion, resulting in significantly lower serum lactate levels at 90 min compared to controls. External shunt DB-REBOA resulted in unstable hemodynamics and no significant metabolic benefit.

Conclusion

Preservation of distal perfusion using an internal shunt markedly improved survival and physiological stability during prolonged Zone 1 aortic occlusion. This strategy may extend the safe duration of REBOA when definitive hemorrhage control is delayed. The development of a new REBOA catheter for this purpose is anticipated.