Crystalloids as an alternative to whole blood in pREBOA resuscitation for hemorrhagic shock

INTRODUCTION: Trauma is a leading global health challenge, with hemorrhage being a major cause of preventable death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) effectively halts hemorrhage but poses risks such as ischemic injury, especially to the kidneys. Partial REBOA (pREBOA) mitigates these effects by allowing limited distal blood flow. This study investigates crystalloid resuscitation as an alternative to whole blood during pREBOA release in a swine model, where all groups received an additional 2000 mL of Ringer's acetate prior to balloon deflation. MATERIALS AND METHODS: 15 castrated male swine weighing 51-65 kg underwent controlled mean (SD) hemorrhage of 1200 (233) mL, followed by 60 minutes of pREBOA application and a 20-minute resuscitation phase, where the animals were randomized into three groups: low Ringer's acetate (0 mL) (n=5), high Ringer's acetate (2000 mL) (n=5), or whole blood transfusion (1000 mL)+ Ringer's acetate (1000 mL) (n=5). Hemodynamic variables, metabolic parameters, and renal blood flow were continuously monitored. Animals were observed for 60 minutes post-REBOA deflation. RESULTS: High-volume Ringer's acetate improved stroke volume compared to low-volume crystalloids (p