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Esmolol reduces myocardial injury induced by resuscitative endovascular balloon occlusion of the aorta (REBOA) in a porcine model of hemorrhagic shock.
Hoareau, Guillaume L; Beyer, Carl A; Caples, Connor M; Spruce, Marguerite W; Gilbert, Zachary; Grayson, J Kevin; Neff, Lucas P; Williams, Timothy K; Johnson, M Austin.
Afiliación
  • Hoareau GL; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA; Division of Emergency Medicine, University of Utah Health, 30N 1900 E, Salt Lake City, UT 84132, USA. Electronic address: guillaume.hoareau@utah.edu.
  • Beyer CA; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA; Department of Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: cbeyer@ucdavis.edu.
  • Caples CM; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA; Department of Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: cmcaples@ucdavis.edu.
  • Spruce MW; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA; Department of Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: mfwinkler@ucdavis.edu.
  • Gilbert Z; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA. Electronic address: zachary.gilbert.1@us.af.mil.
  • Grayson JK; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA. Electronic address: john.k.grayson.civ@mail.mil.
  • Neff LP; Department of Surgery, Wake Forest Baptist Medical Center, Medical Center Bld F4, Winston-Salem, NC 27157, USA. Electronic address: lpneff@wakehealth.edu.
  • Williams TK; Department of Surgery, Wake Forest Baptist Medical Center, Medical Center Bld F4, Winston-Salem, NC 27157, USA.
  • Johnson MA; Clinical Investigation Facility, David Grant USAF Medical Center, 101 Bodin Circle, Travis Air Force Base, CA 94533, USA; Division of Emergency Medicine, University of Utah Health, 30N 1900 E, Salt Lake City, UT 84132, USA. Electronic address: austin.johnson@utah.edu.
Injury ; 51(10): 2165-2171, 2020 Oct.
Article en En | MEDLINE | ID: mdl-32669205
PURPOSE: Resuscitative endovascular balloon occlusion of the aorta (REBOA) causes myocardial injury from increased aortic afterload and supraphysiologic cardiac output. However, pharmacologic methods to attenuate high cardiac output and reduce myocardial injury have not been explored. We hypothesized that the use of esmolol during REBOA would reduce myocardial injury. METHODS: Ten pigs were anesthetized and instrumented. Following 25% total blood volume hemorrhage, animals underwent 45 min of supraceliac (zone 1) REBOA with or without titration of esmolol to maintain heart rate between 80 and 100 beats per minute. Following the REBOA interventions, animals underwent 275 min of standardized critical care. RESULTS: During REBOA, heart rate was significantly lower in the esmolol group compared to control animals (100 [88 - 112] vs 193 [172 - 203] beats/minute, respectively, p < 0.001) and the average mean arterial pressure (MAP) was lower in the esmolol group (88.0 [80.3-94.9] vs 135.1 [131.7-140.4] mmHg, respectively, p = 0.01). During the critical care phase, there were no differences in heart rate or MAP between groups. Animals in the intervention group received 237.9 [218.7-266.5] µg/kg of esmolol. There was a significant increase from baseline in serum troponins for the control group (p = 0.006) and significantly more subendocardial hemorrhage compared to animals treated with esmolol (3 [3 - 3] and 0 [0 - 0], p = 0.009, respectively). CONCLUSION: In our porcine model of hemorrhagic shock, zone 1 REBOA was associated with myocardial injury. Pharmacologic heart rate titration with esmolol during occlusion may mitigate the deleterious effects of REBOA on the heart.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Hemorrágico / Oclusión con Balón / Procedimientos Endovasculares Límite: Animals Idioma: En Revista: Injury Año: 2020 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Choque Hemorrágico / Oclusión con Balón / Procedimientos Endovasculares Límite: Animals Idioma: En Revista: Injury Año: 2020 Tipo del documento: Article Pais de publicación: Países Bajos