We would like to acknowledge Rachel O&#39;Connell,&#160;and Jessica Lee for their assistance with the animal studies. We would also like to acknowledge Maj. General Harold Timboe, MD, MPH, U.S. Army (Ret.), who has been an advisor and mentor for this project.

<ol>
	<li>Kauvar, D. S., Lefering, R., Wade, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+hemorrhage+on+trauma+outcome:+an+overview+of+epidemiology,+clinical+presentations,+and+therapeutic+considerations.">Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations.</a> The Journal of Trauma: Injury, Infection and Critical. 60, S3-S11 (2006).</li><li>Kauvar, D. S., Wade, C. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+epidemiology+and+modern+management+of+traumatic+hemorrhage:+US+and+international+perspectives.">The epidemiology and modern management of traumatic hemorrhage: US and international perspectives.</a> Critical Care. 9, S1-S9 (2005).</li><li>Mattox, K. L., Allen, M. K., Feliciano, D. V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparotomy+in+the+emergency+department.">Laparotomy in the emergency department.</a> Journal of the American College of Emergency Physicians. 8 (5), 180-183 (1979).</li><li>Pust, G. D., Namias, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resuscitative+thoracotomy.">Resuscitative thoracotomy.</a> International Journal of Surgery. 33 (Pt B), 202-208 (2016).</li><li>Burlew, C. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Trauma+Association+critical+decisions+in+trauma:+resuscitative+thoracotomy.">Trauma Association critical decisions in trauma: resuscitative thoracotomy.</a> Journal of Trauma and Acute Care Surgery. 73 (6), 1359-1363 (2012).</li><li>DuBose, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+AAST+prospective+Aortic+Occlusion+for+Resuscitation+in+Trauma+and+Acute+Care+Surgery+(AORTA)+registry:+Data+on+contemporary+utilization+and+outcomes+of+aortic+occlusion+and+resuscitative+balloon+occlusion+of+the+aorta+(REBOA).">The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA).</a> Journal of Trauma and Acute Care Surgery. 81 (3), 409-419 (2016).</li><li>Biffl, W. L., Fox, C. J., Moore, E. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+REBOA+in+the+control+of+exsanguinating+torso+hemorrhage.">The role of REBOA in the control of exsanguinating torso hemorrhage.</a> Journal of Trauma and Acute Care Surgery. 78 (5), 1054-1058 (2015).</li><li>Manzano Nunez, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+meta-analysis+of+resuscitative+endovascular+balloon+occlusion+of+the+aorta+(REBOA)+or+open+aortic+cross-clamping+by+resuscitative+thoracotomy+in+non-compressible+torso+hemorrhage+patients.">A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients.</a> World Journal of Emergency Surgery. 12, 30 (2017).</li><li>Gupta, B. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+intra-aortic+balloon+occlusion+in+penetrating+abdominal+trauma.">The role of intra-aortic balloon occlusion in penetrating abdominal trauma.</a> Journal of Trauma. 29 (6), 861-865 (1989).</li><li>Inoue, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resuscitative+endovascular+balloon+occlusion+of+the+aorta+might+be+dangerous+in+patients+with+severe+torso+trauma:+A+propensity+score+analysis.">Resuscitative endovascular balloon occlusion of the aorta might be dangerous in patients with severe torso trauma: A propensity score analysis.</a> Journal of Trauma and Acute Care Surgery. 80 (4), 559-566 (2016).</li><li>Russo, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extending+the+golden+hour:+Partial+resuscitative+endovascular+balloon+occlusion+of+the+aorta+in+a+highly+lethal+swine+liver+injury+model.">Extending the golden hour: Partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model.</a> Journal of Trauma and Acute Care Surgery. 80 (3), 378-380 (2016).</li><li>Russo, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Partial+Resuscitative+Endovascular+Balloon+Occlusion+of+the+Aorta+in+Swine+Model+of+Hemorrhagic+Shock.">Partial Resuscitative Endovascular Balloon Occlusion of the Aorta in Swine Model of Hemorrhagic Shock.</a> Journal of the American College of Surgeons. 223 (2), 359-368 (2016).</li><li>Williams, T. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Extending+resuscitative+endovascular+balloon+occlusion+of+the+aorta:+Endovascular+variable+aortic+control+in+a+lethal+model+of+hemorrhagic+shock.">Extending resuscitative endovascular balloon occlusion of the aorta: Endovascular variable aortic control in a lethal model of hemorrhagic shock.</a> The Journal of Trauma and Acute Care Surgery. 81 (2), 294-301 (2016).</li><li>Hannon, J. P., Swindle, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemorrhage+and+hemorrhagic-shock+in+swine:+A+review.">Hemorrhage and hemorrhagic-shock in swine: A review.</a> Swine as Models in Biomedical Research. , 197-245 (1992).</li><li>Garry, B. P., Bivens, H. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+Seldinger+technique.">The Seldinger technique.</a> Journal of Cardiothorac Anesthesia. 2 (3), 403 (1988).</li><li>Halaweish, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Addition+of+low-dose+valproic+acid+to+saline+resuscitation+provides+neuroprotection+and+improves+long-term+outcomes+in+a+large+animal+model+of+combined+traumatic+brain+injury+and+hemorrhagic+shock.">Addition of low-dose valproic acid to saline resuscitation provides neuroprotection and improves long-term outcomes in a large animal model of combined traumatic brain injury and hemorrhagic shock.</a> The Journal of Trauma and Acute Care Surgery. 79 (6), 911-919 (2015).</li><li>Alam, H. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surviving+blood+loss+without+blood+transfusion+in+a+swine+poly-trauma+model.">Surviving blood loss without blood transfusion in a swine poly-trauma model.</a> Surgery. 146 (2), 325-333 (2009).</li><li>Jin, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Traumatic+brain+injury+and+hemorrhagic+shock:+evaluation+of+different+resuscitation+strategies+in+a+large+animal+model+of+combined+insults.">Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults.</a> Shock. 38 (1), 49-56 (2012).</li><li>Nikolian, V. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Valproic+acid+decreases+brain+lesion+size+and+improves+neurologic+recovery+in+swine+subjected+to+traumatic+brain+injury,+hemorrhagic+shock,+and+polytrauma.">Valproic acid decreases brain lesion size and improves neurologic recovery in swine subjected to traumatic brain injury, hemorrhagic shock, and polytrauma.</a> The Journal of Trauma and Acute Care Surgery. 83 (6), 1066-1073 (2017).</li><li>Langeland, H., Lyng, O., Aadahl, P., Skjaervold, N. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+coherence+of+macrocirculation,+microcirculation,+and+tissue+metabolic+response+during+nontraumatic+hemorrhagic+shock+in+swine.">The coherence of macrocirculation, microcirculation, and tissue metabolic response during nontraumatic hemorrhagic shock in swine.</a> Physiological Reports. 5 (7), (2017).</li><li>Johnson, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+effect+of+resuscitative+endovascular+balloon+occlusion+of+the+aorta,+partial+aortic+occlusion+and+aggressive+blood+transfusion+on+traumatic+brain+injury+in+a+swine+multiple+injuries+model.">The effect of resuscitative endovascular balloon occlusion of the aorta, partial aortic occlusion and aggressive blood transfusion on traumatic brain injury in a swine multiple injuries model.</a> Journal of Trauma Acute Care Surgery. 83 (1), 61-70 (2017).</li><li>Theisen, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ventral+recumbency+is+crucial+for+fast+and+safe+orotracheal+intubation+in+laboratory+swine.">Ventral recumbency is crucial for fast and safe orotracheal intubation in laboratory swine.</a> Laboratory Animals. 43 (1), 96-101 (2009).</li><li>Li, Y., Alam, H. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Modulation+of+acetylation:+creating+a+pro-survival+and+anti-inflammatory+phenotype+in+lethal+hemorrhagic+and+septic+shock.">Modulation of acetylation: creating a pro-survival and anti-inflammatory phenotype in lethal hemorrhagic and septic shock.</a> Journal of Biomedicine and Biotechnology. 2011, 523481 (2011).</li><li>Nikolian, V. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Valproic+acid+decreases+brain+lesion+size+and+improves+neurologic+recovery+in+swine+subjected+to+traumatic+brain+injury,+hemorrhagic+shock,+and+polytrauma.">Valproic acid decreases brain lesion size and improves neurologic recovery in swine subjected to traumatic brain injury, hemorrhagic shock, and polytrauma.</a> The Journal of Trauma and Acute Care Surgery. 83 (6), 1066-1073 (2017).</li><li>Dekker, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normal+saline+influences+coagulation+and+endothelial+function+after+traumatic+brain+injury+and+hemorrhagic+shock+in+pigs.">Normal saline influences coagulation and endothelial function after traumatic brain injury and hemorrhagic shock in pigs.</a> Surgery. 156 (3), 556-563 (2014).</li><li>Causey, M. W., McVay, D. P., Miller, S., Beekley, A., Martin, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+of+Combat+Gauze+in+extreme+physiologic+conditions.">The efficacy of Combat Gauze in extreme physiologic conditions.</a> The Journal of Surgical Research. 177 (2), 301-305 (2012).</li><li>Frankel, D. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Physiologic+response+to+hemorrhagic+shock+depends+on+rate+and+means+of+hemorrhage.">Physiologic response to hemorrhagic shock depends on rate and means of hemorrhage.</a> The Journal of Surgical Research. 143 (2), 276-280 (2007).</li><li>Morrison, J. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+inflammatory+sequelae+of+aortic+balloon+occlusion+in+hemorrhagic+shock.">The inflammatory sequelae of aortic balloon occlusion in hemorrhagic shock.</a> The Journal of Surgical Research. 191 (2), 423-431 (2014).</li><li>White, J. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+porcine+model+for+evaluating+the+management+of+noncompressible+torso+hemorrhage.">A porcine model for evaluating the management of noncompressible torso hemorrhage.</a> Journal of Trauma. 71, S131-S138 (2011).</li><li>Alam, H. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Putting+life+on+hold-for+how+long?+Profound+hypothermic+cardiopulmonary+bypass+in+a+Swine+model+of+complex+vascular+injuries.">Putting life on hold-for how long? Profound hypothermic cardiopulmonary bypass in a Swine model of complex vascular injuries.</a> Journal of Trauma. 64 (4), 912-922 (2008).</li><li>Bebarta, V. S., Daheshia, M., Ross, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+significance+of+splenectomy+in+experimental+swine+models+of+controlled+hemorrhagic+shock.">The significance of splenectomy in experimental swine models of controlled hemorrhagic shock.</a> The Journal of Trauma and Acute Care Surgery. 75 (5), 920 (2013).</li><li>Georgoff, P. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Alterations+in+the+human+proteome+following+administration+of+valproic+acid.">Alterations in the human proteome following administration of valproic acid.</a> Journal of Trauma and Acute Care Surgery. 81 (6), 1020-1027 (2016).</li><li>Dekker, S. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Different+resuscitation+strategies+and+novel+pharmacologic+treatment+with+valproic+acid+in+traumatic+brain+injury.">Different resuscitation strategies and novel pharmacologic treatment with valproic acid in traumatic brain injury.</a> Journal of Neuroscience Research. 96 (4), 711-719 (2017).</li><li>Georgoff, P. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+and+Tolerability+of+Intravenous+Valproic+Acid+in+Healthy+Subjects:+A+Phase+I+Dose-Escalation+Trial.">Safety and Tolerability of Intravenous Valproic Acid in Healthy Subjects: A Phase I Dose-Escalation Trial.</a> Clinical Pharmacokinetics. 57 (2), 209-219 (2017).</li></ol>

This work is supported by the US Army Medical Research and Materiel Command under Contract No. W81XWH-16-C-0102. The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.

In this protocol, we highlighted a hemorrhagic shock model in swine. This model has been shown to be both reliable and reproducible16,17,18,19. Models similar to this have been employed in several scientific studies investigating the effects of hemorrhagic shock on animal physiology16,20. Furthermore, this model has also been used for t...

Hemorrhage continues to be the dominant cause of preventable deaths in patients undergoing traumatic events, accounting for 90% of trauma-related deaths in the military setting and 40% of post-traumatic deaths in the civilian population1,2. Although direct pressure can treat compressible hemorrhage, non-compressible torso hemorrhage remains difficult to treat and can be lethal without prompt hemostatic control. The historical approach of resuscitative thoracotomy or laparotomy with aortic cross-clamping has proved to be extremely invasive3,4. This intervention also requires a complex selection algorithm to determine the candidacy of patients that have undergone traumatic insults5.
In recent years, there has been a resurgence of interest in a previously described approach&#8212;resuscitative endovascular balloon occlusion of the aorta (REBOA)6,7,8. Although REBOA has conferred a short-term survival advantages in hemorrhage, a prolonged complete occlusion of the aorta during balloon inflation poses serious concerns that include irreversible end-organ ischemia9,10. In an attempt to overcome this potential morbidity, alternative endovascular strategies to manage hemorrhage are being devised. One such strategy that has seen a growing attention is a partial occlusion of the aorta11,12. The idea of partial aortic balloon occlusion affords the perfusion of vascular beds distal to the site of occlusion, improved physiologic proximal aortic MAPs, and a gradual afterload reduction following the balloon deflation. These changes in parameters are desired modifications to the physiological characteristics of a bleeding animal. Prior to this method&#39;s translation to humans, complete and partial aortic balloon occlusion catheters have been heavily tested in swine models of hemorrhagic shock11,12,13.
Swine have been used in studies entailing hemorrhagic shock for many years. Most of the current understanding of the pathophysiology of hemorrhagic shock is derived from studies that have utilized animal models, including swine. Their physiology and homeostatic responses in the setting of pathologic volume depletion following hemorrhage, especially those pertaining to blood clotting and cardiovascular responses, have been well-documented and are like those in humans14. Swine models of hemorrhagic shock also provide opportunities to investigate treatment strategies for hemorrhagic shock and other traumatic injuries.
In this study, we demonstrate a clinically realistic model of hemorrhagic shock in swine to evaluate endovascular treatment strategies, including complete and partial aortic balloon occlusion. We hypothesize that a partial occlusion of the aorta results in a better physiologic and laboratory profile compared to a complete occlusion of the aorta in swine undergoing a controlled fixed-volume hemorrhage.
We aimed to compare the physiologic effects of partial and complete aortic occlusion as a treatment for hemorrhagic shock in a swine model. Partial aortic occlusion was achieved using a selective aortic balloon occlusion in trauma (SABOT) catheter (Figure 1). The SABOT catheter is a two-balloon system that allows intra-luminal blood flow, thereby providing a partial aortic flow to the vascular beds distal to the occlusion. Complete aortic occlusion was achieved using a single-balloon aortic occlusion catheter (e.g.,CODA) (Figure 1). Treatment groups were randomized to undergo resuscitative aortic occlusion either with the complete or with the partial aortic balloon occlusion catheters (n = 2/group).
The major steps of the model include the induction of anesthesia and intubation, the maintenance of anesthesia, instrumentation, 35% TBV hemorrhage (20 min total; half over the first 7 min, and half over the remaining 13 min), aortic balloon occlusion and whole-blood resuscitation (60 min of occlusion; 20% whole-blood resuscitation during the last 20 min of the occlusion), critical care monitoring (240 min) with hemodynamic observation, and euthanasia with tissue harvesting. Figure 2 demonstrates the model utilized in this experiment.

<table>
	<tbody>
		<tr>
			<td>Yorkshire-Landrace Swine</td>
			<td>Michigan State University Veterinary Farm</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Anesthesia: Telazol</td>
			<td>Pfizer</td>
			<td></td>
			<td>Dose: 2-8 mg/kg; IM</td>
		</tr>
		<tr>
			<td>Anti-cholinergic: Atropine</td>
			<td>Pfizer</td>
			<td></td>
			<td>Dose: 1mg, IM</td>
		</tr>
		<tr>
			<td>Anesthesia: Isoflurane</td>
			<td>Baxter</td>
			<td></td>
			<td>Dose: 1-5%, INH</td>
		</tr>
		<tr>
			<td>Betadine</td>
			<td>Humco</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Alcohol 70%</td>
			<td>Humco</td>
			<td>NDC 0395-4202-28</td>
			<td></td>
		</tr>
		<tr>
			<td>Datex-Aespire Anesthesia Machine</td>
			<td>GE Healthcare</td>
			<td>7900</td>
			<td></td>
		</tr>
		<tr>
			<td>Endotracheal tube</td>
			<td>DEE Veterinary</td>
			<td>20170518</td>
			<td>Appropriate size for animal (6.5 or 7.0F)</td>
		</tr>
		<tr>
			<td>Laryngoscope</td>
			<td>Miller</td>
			<td>85-0045</td>
			<td></td>
		</tr>
		<tr>
			<td>Stylet</td>
			<td>Hudson RCI</td>
			<td>5-151--1</td>
			<td></td>
		</tr>
		<tr>
			<td>Jelco 20G IV Catheter</td>
			<td>Smiths Medical</td>
			<td>4054</td>
			<td></td>
		</tr>
		<tr>
			<td>Operating Room Monitor (Vital Signs Monitor)</td>
			<td>SurgiVet Advisor</td>
			<td>V9201</td>
			<td>May require at least 2</td>
		</tr>
		<tr>
			<td>Surgical Gowns</td>
			<td>Kimberly Clark</td>
			<td>90142</td>
			<td>Use appropriate size for surgeon.</td>
		</tr>
		<tr>
			<td>Sterile surgical gloves</td>
			<td>Cardinal Health (Allegiance)</td>
			<td>22537-570</td>
			<td>Use appropriate size for surgeon.</td>
		</tr>
		<tr>
			<td>Cautery Pencil</td>
			<td>Medline</td>
			<td>ESPB 2000</td>
			<td></td>
		</tr>
		<tr>
			<td>Suction tubing</td>
			<td>Medline</td>
			<td>DYND50251</td>
			<td></td>
		</tr>
		<tr>
			<td>Sunction tip: Yankauer</td>
			<td>Medline</td>
			<td>DYND50130</td>
			<td></td>
		</tr>
		<tr>
			<td>Bovie Aaron 1250 Electrocautery Unit</td>
			<td>Bovie Medical Co. FL</td>
			<td>BOV-A1250U</td>
			<td></td>
		</tr>
		<tr>
			<td>Salpel Blade - Size #10</td>
			<td>Cardinal Health (Allegiance)</td>
			<td>32295-010</td>
			<td></td>
		</tr>
		<tr>
			<td>Scalpel Handle</td>
			<td>Martin</td>
			<td>10-295-11</td>
			<td></td>
		</tr>
		<tr>
			<td>Debakey Forceps</td>
			<td>Roboz</td>
			<td>RS-7562</td>
			<td></td>
		</tr>
		<tr>
			<td>Weitlander Retractor</td>
			<td>Roboz</td>
			<td>RS-8612</td>
			<td></td>
		</tr>
		<tr>
			<td>Mayo Scissors</td>
			<td>Roboz</td>
			<td>RS-76870SC</td>
			<td></td>
		</tr>
		<tr>
			<td>Army-navy Retractor</td>
			<td>Teleflex</td>
			<td>164715</td>
			<td></td>
		</tr>
		<tr>
			<td>Mixter Right-angle Forceps</td>
			<td>Teleflex</td>
			<td>175073</td>
			<td></td>
		</tr>
		<tr>
			<td>5F (1.7 mm) 11 cm Insertion Sheath with 0.35&#34; Guidewire</td>
			<td>Boston Scientific</td>
			<td>16035-05B</td>
			<td></td>
		</tr>
		<tr>
			<td>8F (2.7 mm) 11 cm Insertion Sheath with 0.35&#39;&#39; Guidewire</td>
			<td>Boston Scientific</td>
			<td>16035-08B</td>
			<td></td>
		</tr>
		<tr>
			<td>20G angled Introducer Needle</td>
			<td>Arrow</td>
			<td>AK-09903-S</td>
			<td></td>
		</tr>
		<tr>
			<td>14F (4.78 mm) 13 cm Insertion Sheath with 10F dilator</td>
			<td>Cook Medical</td>
			<td>G08024</td>
			<td></td>
		</tr>
		<tr>
			<td>2-0 Silk 18&#39;&#39; 45 cm</td>
			<td>Ethicon</td>
			<td>A185H</td>
			<td></td>
		</tr>
		<tr>
			<td>3-0 Vicryl 36&#39;&#39; 90 cm</td>
			<td>Ethicon</td>
			<td>J344H</td>
			<td></td>
		</tr>
		<tr>
			<td>3-0 Nylon 18&#39;&#39; 45 cm</td>
			<td>Ethicon</td>
			<td>663G</td>
			<td></td>
		</tr>
		<tr>
			<td>4-0 Prolene 30&#39;&#39; 75 cm</td>
			<td>Ethicon</td>
			<td>8831H</td>
			<td></td>
		</tr>
		<tr>
			<td>20 ml syringe</td>
			<td>Metronic/Covidien</td>
			<td>8881512878</td>
			<td></td>
		</tr>
		<tr>
			<td>3 mL syringe</td>
			<td>Metronic/Covidien</td>
			<td>1180300555</td>
			<td></td>
		</tr>
		<tr>
			<td>6 mL syringe</td>
			<td>Metronic/Covidien</td>
			<td>1180600777</td>
			<td></td>
		</tr>
		<tr>
			<td>1000ml 0.9% Saline</td>
			<td>Baxter</td>
			<td>2B1324X</td>
			<td></td>
		</tr>
		<tr>
			<td>Foley Catheter (18F 30 cc)</td>
			<td>Bard</td>
			<td>0166V18S</td>
			<td></td>
		</tr>
		<tr>
			<td>Urinary Drainage Bag</td>
			<td>Bard</td>
			<td>154002</td>
			<td></td>
		</tr>
		<tr>
			<td>9F 10 cm Insertion Sheath</td>
			<td>Arrow</td>
			<td>AK-09903-S</td>
			<td></td>
		</tr>
		<tr>
			<td>Swan-Ganz pulmonary artery catheter (8F)</td>
			<td>Edwards Lifesciences co. CA</td>
			<td>746F8</td>
			<td></td>
		</tr>
		<tr>
			<td>Carotid Flow Probe System</td>
			<td>Transonic, Ithaca, NY</td>
			<td></td>
			<td>3, 4, or 6 mm probes</td>
		</tr>
		<tr>
			<td>SABOT catheter</td>
			<td>Hayes Inc.</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>CODA balloon catheter</td>
			<td>Cook Medical</td>
			<td>8379144</td>
			<td></td>
		</tr>
		<tr>
			<td>Ultrasound, M-Turbo</td>
			<td>SonoSite</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Amplatz Stiff Guidewire (0.035 inch, 260 cm)</td>
			<td>Cook Medical</td>
			<td>G03460</td>
			<td></td>
		</tr>
		<tr>
			<td>Arterial Blood Gas Syringes</td>
			<td>Smiths Medical</td>
			<td>4041-2</td>
			<td></td>
		</tr>
		<tr>
			<td>Arterial Blood Gas Analyzer</td>
			<td>Nova Biochemical</td>
			<td>ABL800</td>
			<td></td>
		</tr>
		<tr>
			<td>Masterflex Pump</td>
			<td>Cole Palmer</td>
			<td>HV-77921-75</td>
			<td></td>
		</tr>
		<tr>
			<td>Blood Collection Bags</td>
			<td>Terumo</td>
			<td>1BBD606A</td>
			<td></td>
		</tr>
		<tr>
			<td>Macro IV drip set</td>
			<td>Hospira</td>
			<td>12672-28</td>
			<td></td>
		</tr>
		<tr>
			<td>Pentobarbital</td>
			<td>Pfizer</td>
			<td></td>
			<td>Dose: 100 mg/kg; IV</td>
		</tr>
		<tr>
			<td>Eppendorf Tubes</td>
			<td>Sorenson</td>
			<td>11590</td>
			<td></td>
		</tr>
		<tr>
			<td>50 cc conical tubes</td>
			<td>Falcon</td>
			<td>352097</td>
			<td></td>
		</tr>
		<tr>
			<td>Formalin</td>
			<td>Fisherbrand</td>
			<td>431121</td>
			<td></td>
		</tr>
		<tr>
			<td>Bair Hugger Normothermia System</td>
			<td>Arizant Healthcare, Inc.</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

complete and partial aortic occlusion for the treatment of hemorrhagic shock in swine

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the forefront of trauma care in recent years. Since complete aortic occlusion presents serious concerns, the concept of partial aortic occlusion has gained a growing attention. Here, we present a large animal model of hemorrhagic shock to investigate the effects of a novel partial aortic balloon occlusion catheter and compare it with a catheter that works on the principles of complete aortic occlusion. Swine are anesthetized and instrumented in order to conduct controlled fixed-volume hemorrhage, and hemodynamic and physiological parameters are monitored. Following hemorrhage, aortic balloon occlusion catheters are inserted and inflated in the supraceliac aorta for 60 min, during which the animals receive whole-blood resuscitation as 20% of the total blood volume (TBV). Following balloon deflation, the animals are monitored in a critical care setting for 4 h, during which they receive fluid resuscitation and vasopressors as needed. The partial aortic balloon occlusion demonstrated improved distal mean arterial pressures (MAPs) during the balloon inflation, decreased markers of ischemia, and decreased fluid resuscitation and vasopressor use. As swine physiology and homeostatic responses following hemorrhage have been well-documented and are like those in humans, a swine hemorrhagic shock model can be used to test various treatment strategies. In addition to treating hemorrhage, aortic balloon occlusion catheters have become popular for their role in cardiac arrest, cardiac and vascular surgery, and other high-risk elective surgical procedures.

Hemodynamic and Physiological Parameters:
The MAP decreased immediately after the hemorrhage (Figures 3A - 3D). During the balloon inflation phase, animals in the complete occlusion group experienced a higher proximal MAP compared to the animals in the partial occlusion group (Figures 3A and 3B). The average distal MAP during the balloon inflation was higher in the...

Watch this Scientific Journal Video about Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine at JoVE.com

Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Here, we present a protocol demonstrating a hemorrhagic shock model in swine that uses aortic occlusion as a bridge to definitive care in trauma. This model has application in testing a wide range of surgical and pharmacological therapeutic strategies.

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the ...

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Research

JoVE Journal

Medicine

10.4K Views.  University of Michigan. Here, we present a protocol demonstrating a hemorrhagic shock model in swine that uses aortic occlusion as a bridge to definitive care in trauma. This model has application in testing a wide range of surgical and pharmacological therapeutic strategies.

Video: Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock

It is common knowledge that severe blood loss and traumatic injury can lead to a cascade of detrimental signaling events often resulting in mortality. 1, 2, 3, 4, 5 These signaling events can also lead to sepsis and/or multiple organ dysfunction (MOD). 6, 7, 8, 9 It is critical then to investigate the causes of suppressed immune function and detrimental signaling cascades in order to develop more effective ways to help patients who suffer from traumatic injuries. 10 This fixed pressure Hemorrhagic Shock (HS) procedure, although technically challenging, is an excellent resource for investigation of these pathophysiologic conditions. 11, 12, 13 Advances in the assessment of biological systems, i.e. Systems Biology have enabled the scientific community to further understand complex physiologic networks and cellular communication patterns. 14 Hemorrhagic Shock has proven to be a vital tool for unveiling these cellular communication patterns as they relate to immune function. 15, 16, 17, 18 This procedure can be mastered! This procedure can also be used as either a fixed volume or fixed pressure approach. We adapted this technique in the murine model to enhance research in innate and adaptive immune function. 19, 20, 21 Due to their small size HS in mice presents unique challenges. However due to the many available mouse strains, this species represents an unparalleled resource for the study of the biologic responses. The HS model is an important model for studying cellular communication patterns and the responses of systems such as hormonal and inflammatory mediator systems, and danger signals, i.e. DAMP and PAMP upregulation as it elicits distinct responses that differ from other forms of shock. 22, 23, 24, 25 The development of transgenic murine strains and the induction of biologic agents to inhibit specific signaling have presented valuable opportunities to further elucidate our understanding of the up and down regulation of signal transduction after severe blood loss, i.e. HS and trauma 26, 27, 28, 29, 30. 
There are numerous resuscitation methods (R) in association with HS and trauma. 31, 32, 33, 34 A fixed volume resuscitation method of solely lactated ringer solution (LR), equal to three times the shed blood volume, is used in this model to study endogenous mechanisms such as remote organ injury and systemic inflammation. 35, 36, 38 This method of resuscitation is proven to be effective in evaluating the effects of HS and trauma 38, 39.

The Hemorrhagic Shock model has been a reliable and reproducible resource facilitating the identification and understanding of signaling cascades associated with inflammation and end-organ damage after trauma. This article provides a step-by-step description of surgical and mechanical aspects associated with the Hemorrhagic Shock experimental procedure in mice.

It is common knowledge that severe blood loss and traumatic injury can lead to a cascade of detrimental signaling events often resulting in mortality. 1, ...

Orthotopic Aortic Transplantation in Mice for the Study of Vascular Disease

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. This is largely true, but there are a number of important principles that can reduce the difficulty of these procedures and enhance reproducibility. Orthotopic aortic transplantation is an excellent procedure in which to learn these principles because it involves only two end-to-end anastomoses, but requires good suturing technique and handling of the vessels for consistent success. This procedure begins with the procurement of a length of abdominal aorta from a donor animal, followed by division of the native aorta in the recipient. The procured aorta is then placed between the divided ends of the recipient aorta and sutured into place using end-to-end anastomoses. To accomplish this objective successfully requires a high degree of concentration, good tools, a steady hand, and an appreciation of how easily the vasculature of a mouse can be damaged, resulting in thrombosis. Learning these important principles is what occupies most of the beginner's time when learning microsurgery in small rodents. Throughout this protocol, we refer to these important points. This model can be used to study vascular disease in a variety of different experimental systems1-8. In the context shown here, it is most often used for the study of post-transplant vascular disease, a common long-term complication of solid organ transplantation in which intimal hyperplasia occurs within the allograft. The primary advantage of the model is that it facilitates quantitative morphometric analyses and the transplanted vessel lies contiguous to the endogenous vessel, which can serve as an additional control9. The technique shown here is most often used for mice weighing 18-25 grams. We have accumulated most of our experience using the C57BL/6J, BALB/cJ, and C3H/HeJ strains.

We describe a technique in which a section of the abdominal aorta from a mouse is transplanted orthotopically to just below the renal arteries in an allogeneic or syngeneic recipient. This technique can be useful in studies in which transplantation of large arteries of uniform size is deemed advantageous.

Vascular procedures involving anastomoses in the mouse are generally thought to be difficult and highly dependent on the skill of the individual surgeon. ...

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow (ischemia) 1. Middle cerebral artery (MCA) delivers a great majority of blood to the lateral surface of the cortex 2, is the most common site of human stroke 3, and ischemia within its territory can result in extensive dysfunction or death 1,4,5. Survivors of ischemic stroke often suffer loss or disruption of motor capabilities, sensory deficits, and infarct. In an effort to capture these key characteristics of stroke, and thereby develop effective treatment, a great deal of emphasis is placed upon animal models of ischemia in MCA.
Here we present a method of permanently occluding a cortical surface blood vessel. We will present this method using an example of a relevant vessel occlusion that models the most common type, location, and outcome of human stroke, permanent middle cerebral artery occlusion (pMCAO). In this model, we surgically expose MCA in the adult rat and subsequently occlude via double ligature and transection of the vessel. This pMCAO blocks the proximal cortical branch of MCA, causing ischemia in all of MCA cortical territory, a large portion of the cortex. This method of occlusion can also be used to occlude more distal portions of cortical vessels in order to achieve more focal ischemia targeting a smaller region of cortex. The primary disadvantages of pMCAO are that the surgical procedure is somewhat invasive as a small craniotomy is required to access MCA, though this results in minimal tissue damage. The primary advantages of this model, however, are: the site of occlusion is well defined, the degree of blood flow reduction is consistent, functional and neurological impairment occurs rapidly, infarct size is consistent, and the high rate of survival allows for long-term chronic assessment.

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection

We describe a highly reproducible method for the permanent occlusion of a rodent major cerebral blood vessel. This technique can be accomplished with very little peripheral damage, minimal blood loss, a high rate of long-term survival, and consistent infarct volume commensurate with the human clinical population.

Stroke is a leading cause of death, disability, and socioeconomic loss worldwide. The majority of all strokes result from an interruption in blood flow ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

2-Methacryloyloxyethyl Phosphorylcholine Polymer Treatment of Complete Dentures to Inhibit Denture Plaque Deposition

Removable dentures made of poly (methyl methacrylate) (PMMA) are prone to bacterial adherence and dental plaque formation, which is called denture plaque. Denture plaque-associated infection is a source of serious dental and medical complications in the elderly. 2-Methacryloyloxyethyl phosphorylcholine (MPC) is a well-known biomedical material that exhibits marked antithrombogenicity and tissue compatibility because of its high resistance to protein adsorption and cell adhesion. Therefore, MPC polymer coatings are suggested to have the potential to inhibit plaque deposition on the surface of PMMA dentures. However, coating MPC polymer on the surface of a PMMA denture is a complex procedure that requires specialized equipment, which is regarded as a major barrier to its clinical application. 
Here, we introduce a new MPC polymer treatment procedure that uses poly (MPC-co-BMA-co-MPAz) (PMBPAz) to prevent denture plaque deposition on removable dentures. This procedure enables the MPC coating of PMMA denture surfaces in a simple and stable manner that is resistant to various chemical and mechanical stresses due to the MPC layer of PMBPAz that is covalently bound to the PMMA surface by ultraviolet light irradiation. In addition, the procedure does not require any specialized equipment and can be completed by clinicians within 2 min. We applied this procedure in a clinical setting and demonstrated its clinical utility and efficacy in inhibiting plaque deposition on removable dentures.

Removable poly(methyl methacrylate) (PMMA) dentures are prone to bacterial adherence and plaque formation. Denture plaque-associated infection is a source of serious dental and medical complications in the elderly. This paper introduces a novel protocol to treat PMMA dentures with 2-methacryloyloxyethyl phosphorylcholine polymer, poly(MPC-co-BMA-co-MPAz), to suppress plaque deposition on PMMA dentures.

Removable dentures made of poly (methyl methacrylate) (PMMA) are prone to bacterial adherence and dental plaque formation, which is called denture plaque. ...

Uncontrolled Hemorrhagic Shock Modeled via Liver Laceration in Mice with Real Time Hemodynamic Monitoring

Uncontrolled hemorrhage is an important cause of preventable deaths among trauma patients. We have developed a murine model of uncontrolled hemorrhage via a liver laceration that results in consistent blood loss, hemodynamic alterations, and survival.
Mice undergo a standardized resection of the left-middle lobe of the liver. They are allowed to bleed without mechanical intervention. Hemostatic agents can be administered as pre-treatment or rescue therapy depending on the interest of the investigator. During the time of hemorrhage, real-time hemodynamic monitoring via a left femoral arterial line is performed. Mice are then sacrificed, blood loss is quantified, blood is collected for further analysis, and organs are harvested for analysis of injury. Experimental design is described to allow for simultaneous testing of multiple animals.
Liver hemorrhage as a model of uncontrolled hemorrhage exists in the literature, primarily in rat and porcine models. Some of these models utilize hemodynamic monitoring or quantify blood loss but lack consistency. The present model incorporates quantification of blood loss, real-time hemodynamic monitoring in a murine model that offers the advantage of using transgenic lines and a high-throughput mechanism to further investigate the pathophysiologic mechanisms in uncontrolled hemorrhage.

Uncontrolled hemorrhage, an important cause of mortality among trauma patients, can be modeled using a standard liver laceration in a murine model. This model results in consistent blood loss, survival, and allows for testing hemostatic agents. This article provides the step-by-step process to perform this valuable model.

Uncontrolled hemorrhage is an important cause of preventable deaths among trauma patients. We have developed a murine model of uncontrolled hemorrhage via ...

Reproducible Motor Deficit Following Aortic Occlusion in a Rat Model Of Spinal Cord Ischemia

Spinal cord ischemia is a fatal complication following thoracoabdominal aortic aneurysm surgery. Researchers can investigate the strategies for preventing and treating this complication using experimental models of spinal cord ischemia. The model described here demonstrates varying degrees of paraplegia that relate to the length of occlusion following thoracic aortic occlusion in a rat spinal cord ischemia model.
A 2-Fr. balloon-tipped catheter was advanced through the femoral artery into the descending thoracic aorta until the catheter tip was placed at the left subclavian artery in anesthetized male Sprague-Dawley rats. Spinal cord ischemia was induced by inflating the catheter balloon. After a set period of occlusion (9, 10, or 11 min), the balloon was deflated. Neurologic assessment was performed using the motor deficit index at 24 h after surgery, and the spinal cord was harvested for histopathological examination.
Rats that underwent 9 min of aortic occlusion showed mild and reversible motor impairment in the hind limb. Rats subjected to 10 min of aortic occlusion presented with moderate but reversible motor impairment. Rats subjected to 11 min of aortic occlusion displayed complete and persistent paralysis. The motor neurons in the spinal cord sections were more preserved in rats subjected to shorter duration of aortic occlusion.
Researchers can achieve a reproducible hind limb motor deficit following thoracic aortic occlusion using this spinal cord ischemia model.

This study demonstrates the technique to make a minimally invasive and easily reproducible model of spinal cord ischemia in rats. Various degrees of hind limb motor deficit can be produced by controlling the aortic occlusion time.

Spinal cord ischemia is a fatal complication following thoracoabdominal aortic aneurysm surgery. Researchers can investigate the strategies for preventing ...

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Establishing a Swine Model of Post-myocardial Infarction Heart Failure for Stem Cell Treatment

Although advances have been achieved in the treatment of heart failure (HF) following myocardial infarction (MI), HF following MI remains one of the major causes of mortality and morbidity around the world. Cell-based therapies for cardiac repair and improvement of left ventricular function after MI have attracted considerable attention. Accordingly, the safety and efficacy of these cell transplantations should be tested in a preclinical large animal model of HF prior to clinical use. Pigs are widely used for cardiovascular disease research due to their similarity to humans in terms of heart size and coronary anatomy. Therefore, we sought to present an effective protocol for the establishment of a porcine chronic HF model using closed-chest coronary balloon occlusion of the left circumflex artery (LCX), followed by rapid ventricular pacing induced with pacemaker implantation. Eight weeks later, the stem cells were administered by intramyocardial injection in the peri-infarct area. Then the infarct size, cell survival, and left ventricular function (including echocardiography, hemodynamic parameters, and electrophysiology) were evaluated. This study helps establish a stable preclinical large animal HF model for stem cell treatment.

We sought to establish a swine model of heart failure induced by left circumflex artery blockage and rapid pacing to test the effect and safety of intramyocardial administration of stem cells for cell-based therapies.

Although advances have been achieved in the treatment of heart failure (HF) following myocardial infarction (MI), HF following MI remains one of the major ...

Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for hemorrhage control. With the advent of purpose-built devices, REBOA has become increasingly common in civilian trauma and acute care settings. Currently available REBOA catheters were designed as complete aortic occlusion devices. However, the therapeutic window for complete aortic occlusion is time-limited due to ischemia-reperfusion injury. The partial procedure allows blood flow past the level of occlusion while maintaining targeted proximal pressure, which has been shown to reduce distal ischemia and adjunctive resuscitation requirements in preclinical studies with prolonged occlusion times as compared to traditional complete occlusion.
pREBOA-PRO is the first catheter designed to enable partial and complete aortic occlusion and is currently in limited market release at seven Level I trauma centers in North America. This paper will focus on procedural considerations for REBOA, including patient selection criteria and a comparison of complete and partial aortic occlusion in a simulator, along with highlighting critical steps to improve clinical outcomes. Additionally, this paper reviews a contrast-enhanced CT scan from a trauma patient that shows distal perfusion after 2 h of partial aortic occlusion using this newly designed catheter and discusses representative results from the limited market release to highlight the profound effect of technological innovation on outcomes in vascular emergencies.

A commercial catheter was designed to facilitate true partial resuscitative endovascular balloon occlusion of the aorta (REBOA) and address the complications associated with complete aortic occlusion. Initial clinical reports indicate that partial REBOA improves transition to reperfusion, reduction of distal ischemia, and extension of safe occlusion time compared to complete occlusion.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) devices grew out of a military-civilian partnership to develop new capabilities for ...