Introduction: Resuscitative endovascular balloon occlusion of the aorta (REBOA) limits hemorrhage and augments proximal blood pressure in trauma patients suffering from non-compressible torso hemorrhage. Chest trauma is considered to be a contraindication for the use of REBOA, and there are limited data on the use of REBOA following chest trauma. We examined the effects of REBOA in a swine model of hemorrhagic shock and chest trauma. Methods: Twelve anesthetized swine were randomized to blunt chest trauma with a captive bolt device or no trauma. All animals then underwent controlled hemorrhage followed by 60 minutes of REBOA, were resuscitated with shed blood, and received automated critical care until euthanasia at six hours. Physiologic parameters were continuously monitored. Blood samples and computed tomography images were obtained. Results: There were no baseline differences between groups. Animals with chest trauma had lower average mean arterial pressures (MAP) (105.71.4 mmHg vs 121.91.3 mmHg, P0.001) and heart rate (1542 vs 1662, P0.001) during REBOA. Both groups had similar declines in their PaO2:Fio2 ratios after REBOA (13131 vs 12631, P=0.91). Troponin levels rose significantly over time in both groups (P value?). There was no change in the size of the pulmonary contusions in chest trauma pigs during the experiment (402107 mL vs 356119 mL, P=0.78) although they became denser (-658 Hounsfield Units (HU) vs -572 HU, p=0.05) over time. There was no difference in resuscitation requirements between groups. Conclusions: Proximal MAP augmentation during REBOA is diminished in animals with chest trauma. Pulmonary contusions did not get larger but became denser following aortic occlusion.
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