Dynamic response of the aortic hemodynamic status to endovascular occlusion: A computational fluid dynamics study

The hemodynamic status following occlusion is crucial to the efficacy of resuscitative endovascular balloon occlusion of the aorta (REBOA), but existing information on this topic remains limited. This study clarifies the remodeling effects of REBOA on aortic hemodynamics. A geometric model of the aorta, derived from human imaging, is used to simulate various hemorrhagic scenarios (blood loss = 10 %, 25 %, 35 %, and 40 %) through reductions in cardiac output and increases in heart rate. Fluid-structure interaction simulations are performed to explore the relationship between blood pressure, cerebral perfusion, arterial deformation, and blood loss following thoracic aortic occlusion. The results indicated that, when the cerebral blood flow tolerance is reduced by 50 %, the recommended blood loss range for REBOA use is approximately 23.9-30.8 %, corresponding to an initial blood pressure range of 53-71 mmHg. Blood loss < 16.8 % (>90 mmHg) does not necessitate occlusion, whereas blood loss between 16.8 % and 23.9 % (71-90 mmHg) may lead to supraphysiological blood pressure and excessive arterial wall deformation. Blood loss > 30.8 % (<53 mmHg) impedes the achievement of reasonable pressure levels. These findings suggest that REBOA is effective only within a specific range of blood loss. Exceeding or falling below these thresholds can lead to adverse effects, such as hypertension or hemodynamic instability. These findings hold significant clinical relevance for emergency care.