Three Sequential Balloon Catheters for Vascular Exclusion of the Liver and Aortic Control (one REBOA and two REBOVCs): A Hemorrhage Control Strategy in Suprahepatic Vena Cava Injuries
Bibliographic record
Abstract
Introduction:We hypothesized that sequential deployment of a resuscitative endovascular balloon occlusion in the aorta REBOA, Pringle maneuver, and two Resuscitative balloon occlusion of the inferior vena cava (REBOVC) would provide hepatic vascular exclusion and hemorrhage control. Materials and Methods:Hemodynamic monitoring and splenectomy were performed in seven swine.One REBOA device and two REBOVCs were positioned under fluoroscopy in the thoracic aorta, suprahepatic and infrahepatic inferior vena cava (IVC); 35% of the total blood volume was removed.Hepatic vascular exclusion was performed for 15 minutes during shock through sequential deployment of the REBOA in the thoracic aorta, Pringle maneuver, the REBOVC in the infrahepatic IVC, and the REBOVC in the suprahepatic IVC.Hepatic vascular exclusion was reversed in the following sequence: Deflation of the REBOVC in the suprahepatic IVC, followed by the infrahepatic IVC REBOVC, release of the Pringle, and deflation of the REBOA.Subsequently, a 1.5 cm injury was performed in the suprahepatic IVC.Immediately thereafter, hepatic vascular exclusion was performed for 15 minutes followed by reversal of exclusion; suture repair of the injury was performed in two animals.Results: Hepatic vascular exclusion effectively stopped the bleeding from the suprahepatic IVC injury, significantly increased MAP.The procedure did not aggravate shock assessed by pH, lactate and base excess, and hemodynamics.Reversal of the exclusion led to immediate exsanguination from the suprahepatic IVC injury except after suture repair of the injury.Conclusion: Sequential deployment of REBOA, Pringle maneuver and two REBOVCs provided vascular exclusion of the liver and effectively temporized the hemorrhage from the suprahepatic IVC.Clinical Significance: Vascular exclusion of the liver during operative repair is difficult in the setting of massive bleeding.The procedure described herein is less invasive and effectively controls the bleeding.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".