Small changes, big effects: The hemodynamics of partial and complete aortic occlusion to inform next generation resuscitation techniques and technologies.

Background: The transition from complete aortic occlusion during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) can be associated with hemodynamic instability. Technique refinements and new technologies have been proposed to minimize this effect. In order to inform new techniques and technology, we examined the relationship between blood pressure and aortic flow during the restoration of systemic circulation following aortic occlusion at progressive levels of hemorrhage. Methods: An automated supraceliac aortic clamp, capable of continuously variable degrees of occlusion, was applied in 7 swine. The swine underwent step-wise removal of 40% of their total blood volume in four equal aliquots. After each aliquot, progressive luminal narrowing to the point of complete aortic occlusion was achieved over 5 minutes, sustained for 5 minutes, and then released over 5 minutes. Proximal and distal blood pressure, as well as distal aortic flow, were continuously recorded throughout the study. Results: Upon release of the clamp, hyperemic aortic flow was observed following 10% and 20% hemorrhage (1599mL/min+/-785, p

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