Gastroesophageal Resuscitative Occlusion of the Aorta Prolongs Survival in a Lethal Liver Laceration Model.

BACKGROUND Non-compressible torso hemorrhage management remains a challenge especially in the prehospital setting. We evaluated a device designed to occlude the aorta from the stomach (Gastroesophageal Resuscitative Occlusion of the Aorta (GROA)) for its ability to stop hemorrhage and improve survival in a swine model of lethal liver laceration and compared its performance to Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and controls. METHODS Swine (n = 24) were surgically instrumented and a 30% controlled arterial hemorrhage over 20-minutes was followed by liver laceration. Animals received either GROA, REBOA, or control (no treatment) for 60-minutes. Following intervention, devices were deactivated, and animals received whole blood and crystalloid resuscitation. Animals were monitored for an additional four hours. RESULTS The liver laceration resulted in the onset of class IV shock. Mean arterial blood pressure ((MAP) (standard deviation)) decreased from 84.5 mmHg (11.69 mmHg) to 27.1 mmHg (5.65 mmHg) at the start of the intervention. Seven of eight control animals died from injury prior to the end of the intervention period with a median survival (interquartile) time of 10.5 minutes (12 minutes). All GROA and REBOA animals survived the duration of the intervention period (60-minutes) with median survival times of 86 minutes (232 minutes) and 79 minutes (199 minutes) after resuscitation, respectively. GROA and REBOA animals experienced a significant improvement in survival compared to controls (p = 0.01). REBOA resulted in higher MAP at the end of intervention 114.6 mmHg (22.9 mmHg) compared to GROA 88.2 mmHg (18.72 mmHg), (p = 0.024) as well as increased lactate compared to GROA 13.2 meq/L (1.56 meq/L) vs. 10.5 meq/L (1.89 meq/L), (p = 0.028). Histological examination of the gastric mucosa in surviving animals revealed mild ischemic injury from both GROA and REBOA. CONCLUSIONS GROA and REBOA devices were both effective at temporarily stanching lethal NCTH of the abdomen and prolonging survival. LEVEL OF EVIDENCE Basic Science; Does not require a level of evidence.