| 1. |
- Dogan, Emanuel M., 1984-, et al.
(författare)
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Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation : Aortic Occlusion Level Matters
- 2019
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Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 52:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.HYPOTHESIS: The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.METHODS: Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.RESULTS: During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71-101) to 128 mmHg (CI 107-150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).CONCLUSIONS: Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid-base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).
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| 2. |
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| 3. |
- Hörer, Tal M., 1971-, et al.
(författare)
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A case of partial aortic balloon occlusion in an unstable multi-trauma patient
- 2016
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Ingår i: Trauma. - : Sage Publications. - 1460-4086 .- 1477-0350. ; 18:2, s. 150-154
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Tidskriftsartikel (refereegranskat)abstract
- The usage of aortic balloon occlusion or resuscitative endovascular balloon occlusion of the aorta in trauma management for bleeding control is increasing rapidly as an alternative to thoracotomy and aortic clamping. Little is known about the effects of partial occlusion of the aorta as a bridge to definitive treatment, but one of its advantages may be limited visceral organ ischemia. We describe the first known case of partial aortic balloon occlusion in trauma for reaching a targeted systolic blood pressure, which was used as an adjunctive tool in trauma management and as a bridge to definitive treatment.
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| 4. |
- Hörer, Tal M., 1971-, et al.
(författare)
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A small case series of aortic balloon occlusion in trauma : lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review
- 2016
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer. - 1863-9933 .- 1863-9941. ; 42:5, s. 585-592
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Forskningsöversikt (refereegranskat)abstract
- EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm.We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma.A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented.Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients.EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.
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| 5. |
- Hörer, Tal M., 1971-, et al.
(författare)
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No-touch technique for radiocephalic arteriovenous fistula - surgical technique and preliminary results
- 2016
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Ingår i: Journal of Vascular Access. - : Wichtig Publishing. - 1129-7298 .- 1724-6032. ; 17:1, s. 6-12
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The radiocephalic arteriovenous fistula (RC-AVF) has significant failure rates due to occlusions and failure to mature. The size and quality of the veins are considerable limiting factors for the procedure. The aim of this pilot study was to describe the No-Touch technique (NTT) to create RC-AVF and present the results up to 1 year of follow-up.Methods: Thirty-one consecutive patients who were referred for surgery for a RC-AVF were included (17 men, mean age 63 years, range 35-84) and operated by NTT where the vein and artery were dissected with a tissue cushion around it. Twenty-two patients had small veins or arteries (<= 2 mm), 12 patients had a small cephalic vein (<= 2 mm), and the mean distal cephalic vein diameter was 2.4 mm (range 1.0-4.1 mm).Results: Technical surgical success and immediate patency were obtained in all patients. Clinical success was achieved in 23 of the 27 (85%) patients who required hemodialysis. The proportion of primary patency at 30 days and 6 months was 84% and 64%, respectively. Secondary patency at 30 days and 6 months was 97% and 83%, respectively. At 1-year follow-up, primary patency was 54% and secondary patency was 80%. There was no major difference in patency due to preoperative vein diameter.Conclusions: The results of this study indicate that NTT can be used for primary radio-cephalic fistula surgery with very good results. This method offers the potential to create a RC-AVF in patients who are not usually considered appropriate for a distal arm fistula due to a small cephalic vein.
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| 7. |
- McGreevy, David, 1988-, et al.
(författare)
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Endovascular Resuscitation with Aortic Balloon Occlusion in Non-Trauma Cases : First use of ER-REBOA in Europe
- 2017
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Ingår i: Journal of Endovascular Resuscitation and Trauma Management. - : EVTM Society. - 2002-7567. ; :1, s. 42-49
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Tidskriftsartikel (refereegranskat)abstract
- Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is currently evolving and being used worldwide for trauma management. Smaller sheath devices for REBOA and new advances in endovascular resuscitation methods suggest the potential for the procedure to be utilized in hemodynamically unstable non-trau-matic patients.Methods: We describe five adult patients that underwent hemodynamic control using the 7 Fr sheath ER-REBOA™ catheters for non-traumatic hemorrhagic instability at Örebro University Hospital between February 2017 and June 2017.Results: The ER-REBOA™ catheter was inserted and used successfully for temporary blood pressure stabilization as part of an endovascular resuscitation process.Conclusion: The ER-REBOA™ catheter for endovascular resuscitation may be an additional method for temporary hemodynamic stabilization in the treatment of non-traumatic patients. Furthermore, the ER-REBOA™ catheter may be a potential addition to advanced cardiac life support in the management of non-traumatic cardiac arrest.
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| 8. |
- McGreevy, David, 1988-, et al.
(författare)
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Metabolic Response to Claudication in Peripheral Arterial Disease : a Microdialysis pilot study
- 2019
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Ingår i: Annals of Vascular Surgery. - : Elsevier. - 0890-5096 .- 1615-5947. ; 58, s. 134-141
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In a pilot study investigate the possible use of microdialysis in the calf muscle to assess the metabolic response to intermittent claudication (IC). In addition, evaluate the simultaneous systemic inflammatory reaction.METHODS: With one microdialysis catheter in the gastrocnemic muscle and one subcutaneously in the pectoral region (as a reference), and a peripheral venous catheter, dialysate and venous blood sampling was performed before, during and after walking on a treadmill to maximal tolerable claudication (controls 10 minutes).RESULTS: A total of 9 participants were recruited, six patients with IC and three healthy controls. At baseline, IC and control subjects did not differ in metabolic findings (glucose, lactate, pyruvate, glycerol) in the gastrocnemic muscle. Subcutaneous glucose concentration was higher in controls. After physical exertion, gastrocnemic and subcutaneous glycerol, lactate and pyruvate concentrations increased in IC subjects. Plasma concentrations of Tumor Necrosis Factor--α (TNF- α), Interleucin-6 (IL-6), Interleucin-1ß (IL-1ß), Hepatocyte Growth Factor (HGF) and Vascular Endothelial Growth Factor (VEGF) were higher in IC subjects at baseline, and TNF-α, (IL-6) and Interleukin-18 (IL-18) increased after walking as did IL-6 and (IL-1ß) in controls. The muscle catheters did not show any signs of causing harm.CONCLUSIONS: Microdialysis can be used to study the ongoing metabolic response during walking and claudication. Our results suggest both an acute local and a systemic inflammatory reaction during development of claudication pain.
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| 9. |
- Nilsson, Kristofer F., 1981-, et al.
(författare)
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Organic mononitrites of 1,2-propanediol act as an effective NO-releasing vasodilator in pulmonary hypertension and exhibit no cross-tolerance with nitroglycerin in anesthetized pigs
- 2018
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Ingår i: Drug Design, Development and Therapy. - : DOVE Medical Press Ltd.. - 1177-8881. ; 12, s. 685-694
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Clinically available intravenous (IV) nitric oxide (NO) donor drugs such as nitroglycerin (GTN) cause systemic hypotension and/or tolerance development. In a porcine model, novel NO donor compounds - the organic mononitrites of 1,2-propanediol (PDNO) were compared to GTN with regard to pulmonary selectivity and tolerance development. The vasodilatory effects of inorganic nitrite were investigated.Materials and methods: In anesthetized piglets, central hemodynamics were monitored. At normal pulmonary vascular resistance (PVR), IV infusions of PDNO (15-60 nmol kg(-1) min(-1)), GTN (13-132 nmol kg(-1) min(-1)), and inorganic nitrite (dosed as PDNO) were administered. At increased PVR (by U46619 IV), IV infusions of PDNO (60-240 nmol kg(-1) min(-1)) and GTN (75-300 nmol kg(-1) min(-1)) before and after a 5 h infusion of GTN (45 nmol kg-1 min-1) were given.Results: At normal PVR, PDNO (n=12) and GTN (n=7) caused significant dose-dependent decreases in mean systemic and pulmonary arterial pressures, whereas inorganic nitrite (n=13) had no significant effect. At increased PVR, PDNO (n=6) and GTN (n=6) significantly decreased mean systemic and pulmonary pressures and resistances, but only PDNO reduced the ratio between pulmonary and systemic vascular resistances significantly. After the 5 h GTN infusion, the hemodynamic response to GTN infusions (n=6) was significantly suppressed, whereas PDNO (n=6) produced similar hemodynamic effects to those observed before the GTN infusion.Conclusion: PDNO is a vasodilator with selectivity for pulmonary circulation exhibiting no cross-tolerance to GTN, but GTN causes non selective vasodilatation with substantial tolerance development in the pulmonary and systemic circulations. Inorganic nitrite has no vasodilatory properties at relevant doses.
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| 10. |
- Nilsson, Kristofer F., 1981-, et al.
(författare)
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The novel nitric oxide donor PDNO attenuates ovine ischemia-reperfusion induced renal failure
- 2017
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Ingår i: Intensive Care Medicine Experimental. - London, UK : Springer Science and Business Media LLC. - 2197-425X. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Renal ischemia-reperfusion injury is a common cause of acute kidney injury in intensive care and surgery. Recently, novel organic mononitrites of 1,2-propanediol (PDNO) were synthesized and shown to rapidly and controllably deploy nitric oxide in the circulation when administered intravenously. We hypothesized that intravenous infusion of PDNO during renal ischemia reperfusion would improve post-ischemic renal function and microcirculation.METHODS: Sixteen sheep were anesthetized, mechanically ventilated, and surgically instrumented. The left renal artery was clamped for 90 min, and the effects of ischemia were studied for a total of 8 h. Fifteen minutes prior to the release of the clamp, intravenous infusions of PDNO (n = 8) or vehicle (1,2 propanediol + inorganic nitrite, n = 8) were initiated (180 nmol/kg/min for 30 min, thereafter 60 nmol/kg/min for the remainder of the experiment).RESULTS: Renal artery blood flow, cortical and medullary perfusion, and diuresis and creatinine clearance decreased in the left kidney post ischemia. However, in the sheep treated with PDNO, diuresis and creatinine clearance in the left kidney were significantly higher post ischemia compared to vehicle-treated animals (1.7 ± 0.5 vs 0.7 ± 0.3 ml/kg/h, p = 0.04 and 7.5 ± 2.1 vs 1.7 ± 0.6 ml/min, p = 0.02, respectively). Left renal medullary perfusion and oxygen uptake were higher in the PDNO group (73 ± 9 vs 37 ± 5% of baseline, p = 0.004 and 2.6 ± 0.4 vs 1.6 ± 0.3 ml/min, p = 0.02, respectively). PDNO significantly increased renal oxygen consumption and reduced the oxygen utilization for sodium reabsorption (p = 0.03 for both). Mean arterial blood pressure was significantly reduced by PDNO (83 ± 3 vs 94 ± 3 mmHg, p = 0.02) but was still within normal limits. Total renal blood flow was not affected, and there were no signs of increased blood methemoglobin concentrations or tachyphylaxis.CONCLUSIONS: The novel nitric oxide donor PDNO improved renal function after ischemia. PDNO also prevented the persistent reduction in medullary perfusion during reperfusion and improved renal oxygen utilization without severe side effects.
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