Endocrine effects of simulated complete and partial aortic occlusion in a swine model of hemorrhagic shock

Guillaume L. Hoareau, Timothy K. Williams, Anders J. Davidson, Rachel M. Russo, Sarah Ashley E. Ferencz, Lucas P. Neff, J. Kevin Grayson, Ian J. Stewart, M. Austin Johnson

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Introduction: Low distal aortic flow via partial aortic occlusion (AO) may mitigate ischemia induced by resuscitative endovascular balloon occlusion of the aorta (REBOA). We compared endocrine effects of a novel simulated partial AO strategy, endovascular variable aortic control (EVAC), with simulated REBOA in a swine model. Materials and methods: Aortic flow in 20 swine was routed from the supraceliac aorta through an automated extracorporeal circuit. Following liver injury-induced hemorrhagic shock, animals were randomized to control (unregulated distal flow), simulated REBOA (no flow, complete AO), or simulated EVAC (distal flow of 100-300mL/min after 20 minutes of complete AO). After 90minutes, damage control surgery, resuscitation, and full flow restoration ensued. Critical care was continued for 4.5 hours or until death. Results: Serum angiotensin II concentration was higher in the simulated EVAC (4,769 ± 624 pg/mL) than the simulated REBOA group (2649 ± 429) (p = 0.01) at 180minutes. There was no detectable difference in serum renin [simulated REBOA: 231.3 (227.9-261.4) pg/mL; simulated EVAC: 294.1 (231.2-390.7) pg/mL; p = 0.27], aldosterone [simulated EVAC: 629 (454-1098), simulated REBOA: 777 (575-1079) pg/mL, p = 0.53], or cortisol (simulated EVAC: 141 ± 12, simulated REBOA: 127 ± 9 ng/mL, p = 0.34) concentrations between groups. Conclusions: Simulated EVAC was associated with higher serum angiotensin II, which may have contributed to previously reported cardiovascular benefits. Future studies should evaluate the renal effects of EVAC and the concomitant therapeutic use of angiotensin II.

Original languageEnglish
Article numberusy287
Pages (from-to)e298-e302
JournalMilitary Medicine
Issue number5-6
StatePublished - 1 May 2019
Externally publishedYes




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