IS AORTIC OCCLUSION ADVISABLE IN THE MANAGEMENT OF MASSIVE HEMORRHAGE- EXPERIMENTAL-STUDY IN DOGS

Occlusion of the thoracic aorta is meant to improve cerebral and cardi ac perfusion in the moribund, exsanguinating trauma patient. Yet clini cal and experimental experience shows no evident benefit from this cri tical maneuver, and hind limb paralysis (HLP) is a feared complication . Our study is intended to verify whether aortic occlusion can decreas e further blood loss and therefore be useful during treatment of hemor rhagic shock. Four groups of 10 dogs were submitted to hemorrhagic sho ck and treated with blood (40 mL/kg) and saline (35 mL/kg). Group I wa s then submitted to intermittent intra-aortic occlusion (IIAO), Groups II and III to IIAO and to a second bleeding (rebleeding), and Group I V to rebleeding only, without IIAO. All dogs received volume replaceme nt during this rebleeding phase and were kept alive for 8 days. Five d ogs died and seven had HLP in the three groups submitted to IIAO. Deat h and HLP occurred even in the dogs of Group I, which were not submitt ed to a second bleeding. IIAO reduced blood loss from 139 mL/kg to 48 mL/kg. There were no complications or deaths among the 10 dogs in Grou p IV. Although efficient in reducing blood loss, IIAO was associated w ith a 16% mortality and 23% of HLP, whereas volume replacement alone w as tolerated without complications or death. We conclude that IIAO is dangerous while treating severe hemorrhagic shock even after volume re placement and hemodynamic stabilization.