EVAC versus REBOA in a Swine Model of Hemorrhage and Ischemia Reperfusion Injury

Background Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is effective at limiting hemorrhage from non-compressible sources and restoring, yet causes progressive distal ischemia, supraphysiologic pressures and increased cardiac afterload. Endovascular Variable Aortic Control (EVAC) addresses these limitations, while still controlling hemorrhage. Previous work demonstrated improved outcomes following a 90-minute intervention period in an uncontrolled hemorrhage model. The present study compares automated EVAC to REBOA over an occlusion period reflective of contemporary REBOA usage. Methods Following instrumentation, 12 Yorkshire-cross swine underwent controlled 25% hemorrhage, a 45-minute intervention period of EVAC or REBOA, and subsequent resuscitation with whole blood and critical care for the remainder of a six-hour experiment. Hemodynamics were acquired continuously and laboratory parameters were assessed at routine intervals. Tissue was collected for histopathologic analysis. Results No differences were seen in baseline parameters. During intervention, EVAC resulted in more physiologic proximal pressure augmentation compared to REBOA (101 mmHg vs 129 mmHg 95CI 105-151, p=0.04). During critical care, EVAC animals required less than half the amount of crystalloid (3450 ml 95CI 1215-5684 vs 7400 ml 95CI 6148-8642, p

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