Evaluation of Esmolol as an Adjunct to Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) In a Porcine (Sus scrofa) Model Of non Compressible Torso Hemorrhage

摘要

Objectives: To evaluate if esmolol infusion during resuscitative endovascular balloon occlusion of the aorta (REBOA) could mitigate cardiac injury. Methods: Swine were anesthetized and instrumented. Hemorrhagic shock was induced via removal of 25 of the animals estimated blood volume over 30 minutes. At the end of the hemorrhage period, the zone 1 balloon was inflated for 45 minutes; during the AO period, esmolol infusion rate was titrated to maintain heart rate between 80-100 beats per minute in the intervention group. The esmolol infusion was discontinued at the beginning of balloon deflation. Shed blood was transfused to the animal over 20 minutes at T65. In both groups, the aortic balloon was deflated over 10 minutes. Results: Heart rate was significantly higher in the control group than in the esmolol group during aortic occlusion (193 [172 -203] and 99 [87 -108], respectively, p 0.001 ). There was a significant difference in troponin concentrations over time (p=0.03) and between groups (0.003). There was no difference in serum troponin concentration over time in the esmolol group (p=0.054), it was significantly higher than baseline at T360 in the control group (p=0.006). Conclusion: Esmolol reduced myocardial injury associated with REBOA.