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Updated: Sep 29, 2025
Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine
Published on: August 24, 2018
Advanced partial occlusion controller allows for increased precision during targeted regional optimization in a
Alexis L Lauria1, Alexander J Kersey, John A Mares
1From the Department of Surgery (A.L.L., A.J.K., P.W.W., J.M.W.), Walter Reed National Military Medical Center; the Department of Surgery (A.L.L., A.J.K., J.A.M., B.D.T., P.W.W., D.M.B., J.M.W.), Medicine (D.M.B) and Anesthesiology (P.B.), Uniformed Services University of the Health Sciences, and the Henry M. Jackson Foundation (J.A.M., and P.B), Bethesda, Maryland.
Background:
Targeted regional optimization (TRO), a partial resuscitative endovascular balloon occlusion of the aorta strategy, may mitigate distal ischemia and extend the window of effectiveness for this adjunct. An automated device may allow greater control and precise regulation of flow past the balloon, while being less resource-intensive. The objective of this study was to assess the technical feasibility of the novel advanced partial occlusion controller (APOC) in achieving TRO at multiple distal pressures.
Methods:
Female swine (n = 48, 68.1 ± 0.7 kg) were randomized to a target distal mean arterial pressure (MAP) of 25 mm Hg, 35 mm Hg, or 45 mm Hg by either manual (MAN) or APOC regulation (n = 8 per group). Uncontrolled hemorrhage was generated by liver laceration. Targeted regional optimization was performed for 85 minutes, followed by surgical control and a 6-hour critical care phase. Proximal and distal MAP and flow rates were measured continuously.
Results:
At a target distal MAP of 25 mm Hg, there was no difference in the MAP attained (APOC: 26.2 ± 1.05 vs. MAN: 26.1 ± 1.78 mm Hg) but the APOC had significantly less deviance (10.9%) than manual titration (14.9%, p < 0.0001). Similarly, at a target distal MAP of 45 mm Hg, there was no difference in mean pressure (44.0 ± 0.900 mm Hg vs. 45.2 ± 1.31 mm Hg) but APOC had less deviance (9.34% vs. 11.9%, p < 0.0001). There was no difference between APOC and MAN in mean (34.6 mm Hg vs. 33.7 mm Hg) or deviance (9.95% vs. 10.4%) at a target distal MAP of 35 mm Hg, respectively. The APOC made on average 77 balloon volume adjustments per experiment compared with 29 by manual titrations.
Conclusion:
The novel APOC consistently achieved and sustained precisely regulated TRO across all groups and demonstrated reduced deviance at the 25 mm Hg and 45 mm Hg groups compared with manual titration.
