{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T00:34:19Z","timestamp":1774571659830,"version":"3.50.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000005","name":"Department of Defense","doi-asserted-by":"publisher","award":["#W81XWH-20-1-0864"],"award-info":[{"award-number":["#W81XWH-20-1-0864"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) temporizes noncompressible torso hemorrhage (NCTH) and provides hemodynamic support, yet is limited by ischemic effects. Intermittent REBOA (iREBOA) and partial REBOA (pREBOA) strategies aim to mitigate these effects. iREBOA alternates between distal flow restoration and full aortic occlusion. pREBOA provides hemodynamic support with attenuated distal flow by dynamically adjusting balloon volume. Hemodynamic profiles differ between these strategies, with an uncertain impact on concomitant injuries like traumatic brain injury (TBI). We hypothesized that pREBOA would demonstrate more consistent cerebral hemodynamics in a porcine model of hemorrhage and TBI.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Sixteen swine underwent standardized TBI, via cortical impactor, and liver transection, followed by 10 minutes of complete REBOA. Swine were then randomized to 80 minutes of automated iREBOA or pREBOA support. Following damage control surgery and whole blood transfusion, 90 minutes of automated closed-loop critical care was implemented. Hemodynamic parameters and ischemia-related laboratory values were recorded. Hypotension was defined as mean arterial pressure (MAP) &amp;lt;\u200960 mmHg, and hypertension as MAP\u2009&amp;gt;\u200970 mmHg.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Carotid flow fluctuated less in pREBOA vs iREBOA at time intervals 0-10 minutes (P\u2009=\u2009.038), 10-20 minutes (P\u2009=\u2009.036), 20-30 minutes (P\u2009=\u2009.001), and 40-50 minutes (P\u2009=\u2009.04). Cerebral perfusion pressure (CPP) varied more in iREBOA than pREBOA at 20-30 minutes and 30-40 minutes (P\u2009=\u2009.0007 and 0.048). There were no statistically significant differences in time spent in hypotension and hypertension for iREBOA and pREBOA (45.26% vs 17.22%, P\u2009=\u2009.27; 38.31% vs 49.19%, P\u2009=\u2009.56).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Partial REBOA with an automated system demonstrated more consistent CPP and carotid flow while maintaining proximal MAP. Dynamic control systems for NCTH are possible, and automation of pREBOA may balance competing risks of distal ischemia and proximal homeostasis in multi-injured trauma patients with TBI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf310","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T07:48:47Z","timestamp":1749023327000},"page":"686-694","source":"Crossref","is-referenced-by-count":1,"title":["Partial Resuscitative Endovascular Balloon Occlusion of the Aorta Versus Intermittent Resuscitative Endovascular Balloon Occlusion of the Aorta in Noncompressible Torso Hemorrhage With Concomitant Traumatic Brain Injury"],"prefix":"10.1093","volume":"190","author":[{"given":"Gloria D","family":"Sanin","sequence":"first","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4550-7835","authenticated-orcid":false,"given":"Elizabeth C","family":"Wood","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micaela K","family":"Gomez","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]},{"name":"The University of Arizona , Tucson, AZ 85719,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel E","family":"Cambronero","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magan R","family":"Lane","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James W","family":"Patterson","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bonnie E","family":"Laingen","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth A","family":"Azar","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Garrett R","family":"Reid","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio C","family":"Renaldo","sequence":"additional","affiliation":[{"name":"University of Maryland School of Medicine , Baltimore, MA 21201,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elaheh","family":"Rahbar","sequence":"additional","affiliation":[{"name":"Texas A&M University , TX 77842,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Austin","family":"Johnson","sequence":"additional","affiliation":[{"name":"University of Utah , Salt Lake City, UT 84132,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucas P","family":"Neff","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy K","family":"Williams","sequence":"additional","affiliation":[{"name":"Wake Forest University School of Medicine , Winston Salem, NC 27157,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2025091919345104800_usaf310-B1","doi-asserted-by":"publisher","first-page":"e76","DOI":"10.1016\/S2468-2667(16)30017-2","article-title":"Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis","volume":"1","author":"Majdan","year":"2016","journal-title":"Lancet Public Health"},{"key":"2025091919345104800_usaf310-B2","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s12873-023-00823-9","article-title":"Incidence and predictors of mortality among traumatic brain injury patients admitted to Amhara region Comprehensive Specialized Hospitals, northwest Ethiopia, 2022","volume":"23","author":"Demlie","year":"2023","journal-title":"BMC Emerg Med"},{"key":"2025091919345104800_usaf310-B3","doi-asserted-by":"publisher","first-page":"S124","DOI":"10.1016\/j.wem.2017.02.002","article-title":"Remote damage control resuscitation in austere environments","volume":"28","author":"Chang","year":"2017","journal-title":"Wilderness Environ Med"},{"key":"2025091919345104800_usaf310-B4","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1097\/TA.0000000000002205","article-title":"The why and how our trauma patients die: a prospective Multicenter Western Trauma Association study","volume":"86","author":"Callcut","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B5","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1097\/TA.0000000000001530","article-title":"Multicenter retrospective study of noncompressible torso hemorrhage: anatomic locations of bleeding and comparison of endovascular versus open approach","volume":"83","author":"Chang","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B6","doi-asserted-by":"publisher","first-page":"e000376","DOI":"10.1136\/tsaco-2019-000376","article-title":"Clinical use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in civilian trauma systems in the USA, 2019: a joint statement from the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, the National Association of Emergency Medical Services Physicians and the National Association of Emergency Medical Technicians","volume":"4","author":"Bulger","year":"2019","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025091919345104800_usaf310-B7","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1097\/TA.0000000000002008","article-title":"Endovascular variable aortic control (EVAC) versus resuscitative endovascular balloon occlusion of the aorta (REBOA) in a swine model of hemorrhage and ischemia reperfusion injury","volume":"85","author":"Williams","year":"2018","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/TA.0000000000002307","article-title":"Efficacy of intermittent versus standard resuscitative endovascular balloon occlusion of the aorta in a lethal solid organ injury model","volume":"87","author":"Kuckelman","year":"2019","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B9","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1097\/TA.0000000000003962","article-title":"Automated partial resuscitative endovascular balloon occlusion of the aorta reduces blood loss and hypotension in a highly lethal porcine liver injury model","volume":"195","author":"Cambronero","year":"2023","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B10","doi-asserted-by":"publisher","first-page":"S133","DOI":"10.1097\/TA.0000000000001146","article-title":"Partial resuscitative balloon occlusion of the aorta (P-REBOA): clinical technique and rationale","volume":"81","author":"Johnson","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B11","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/j.jamcollsurg.2016.04.037","article-title":"Partial resuscitative endovascular balloon occlusion of the aorta in swine model of hemorrhagic shock","volume":"223","author":"Russo","year":"2016","journal-title":"J Am Coll Surg"},{"key":"2025091919345104800_usaf310-B12","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1097\/TA.0000000000000940","article-title":"Extending the golden hour: partial resuscitative endovascular balloon occlusion of the aorta in a highly lethal swine liver injury model","volume":"80","author":"Russo","year":"2016","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B13","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1097\/TA.0000000000001372","article-title":"Automated variable aortic control versus complete aortic occlusion in a swine model of hemorrhage","volume":"82","author":"Williams","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B14","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1097\/TA.0000000000001518","article-title":"The effect of REBOA, partial aortic occlusion and aggressive blood transfusion on traumatic brain injury in a swine polytrauma model","volume":"83","author":"Johnson","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025091919345104800_usaf310-B15","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.jss.2020.12.054","article-title":"Partial resuscitative endovascular balloon occlusion of the aorta: a systematic review of the preclinical and clinical literature","volume":"262","author":"Russo","year":"2021","journal-title":"J Surg Res"},{"key":"2025091919345104800_usaf310-B16","author":"Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Hemorrhagic Shock","year":"2025"},{"key":"2025091919345104800_usaf310-B17","doi-asserted-by":"publisher","first-page":"810","DOI":"10.12659\/ajcr.900267","article-title":"\u201cREBOA\u201d\u2014is it really safe? A case with massive intracranial hemorrhage possibly due to endovascular balloon occlusion of the aorta (REBOA)","volume":"17","author":"Uchino","year":"2016","journal-title":"Am J Case Rep"},{"key":"2025091919345104800_usaf310-B18","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.jss.2017.06.045","article-title":"A novel model of highly lethal uncontrolled torso hemorrhage in swine","volume":"218","author":"Davidson","year":"2017","journal-title":"J Surg Res"},{"key":"2025091919345104800_usaf310-B19","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1097\/SHK.0000000000001917","article-title":"Endovascular perfusion augmentation for critical care decreases vasopressor requirements while maintaining renal perfusion","volume":"57","author":"Patel","year":"2022","journal-title":"Shock"},{"key":"2025091919345104800_usaf310-B20","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1016\/j.jss.2022.06.067","article-title":"Endovascular perfusion augmentation after resuscitative endovascular balloon occlusion of the aorta improves renal perfusion and decreases vasopressors","volume":"279","author":"Patel","year":"2022","journal-title":"J Surg Res"},{"key":"2025091919345104800_usaf310-B21","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jss.2023.09.075","article-title":"Dynamic aortic pressure augmentation as a novel method of swine terminal blood extraction","volume":"294","author":"Niebler","year":"2024","journal-title":"J Surg Res"},{"key":"2025091919345104800_usaf310-B22","doi-asserted-by":"publisher","first-page":"e333","DOI":"10.1016\/j.jvs.2023.03.460","article-title":"Adaptive balloon weaning algorithm with automated REBOA facilitates proximal homeostasis during reperfusion in a swine hemorrhagic shock model","volume":"77","author":"Sanin","year":"2023","journal-title":"J Vasc Surg"},{"key":"2025091919345104800_usaf310-B23","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2024"},{"key":"2025091919345104800_usaf310-B24","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1186\/s12871-022-01617-5","article-title":"Increased normalized lactate load is associated with higher mortality in both sepsis and non-sepsis patients: an analysis of the MIMIC-IV database","volume":"22","author":"Chen","year":"2022","journal-title":"BMC Anesthesiol"},{"key":"2025091919345104800_usaf310-B25","doi-asserted-by":"publisher","first-page":"100623","DOI":"10.1016\/j.tcr.2022.100623","article-title":"REBOA as a bridge to brain CT in a patient with concomitant brain herniation and haemorrhagic shock\u2014A case report","volume":"38","author":"Bissoni","year":"2022","journal-title":"Trauma Case Rep"},{"key":"2025091919345104800_usaf310-B26","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/j.surg.2021.01.043","article-title":"Outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) utilization in trauma patients with and without traumatic brain injuries: a national analysis of the American College of Surgeons Trauma Quality Improvement Program data set","volume":"170","author":"Elkbuli","year":"2021","journal-title":"Surgery"},{"key":"2025091919345104800_usaf310-B27","doi-asserted-by":"publisher","first-page":"115798","DOI":"10.1016\/j.amjsurg.2024.115798","article-title":"Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the presence of associated severe traumatic brain injury: a propensity-score matched study","volume":"237","author":"Chiu","year":"2024","journal-title":"Am J Surg"},{"key":"2025091919345104800_usaf310-B28","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.wneu.2021.11.027","article-title":"Cerebral pressure autoregulation in brain injury and disorders: a review on monitoring, management, and future directions","volume":"158","author":"Svedung Wettervik","year":"2022","journal-title":"World Neurosurg"},{"key":"2025091919345104800_usaf310-B29","doi-asserted-by":"publisher","first-page":"H1118","DOI":"10.1152\/ajpheart.00267.2016","article-title":"Traumatic brain injury-induced autoregulatory dysfunction and spreading depression-related neurovascular uncoupling: pathomechanisms, perspectives, and therapeutic implications","volume":"311","author":"Toth","year":"2016","journal-title":"Am J Physiol-Heart Circ Physiol"},{"key":"2025091919345104800_usaf310-B30","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.anclin.2016.04.002","article-title":"Cerebral blood flow autoregulation and dysautoregulation","volume":"34","author":"Armstead","year":"2016","journal-title":"Anesthesiol Clin"},{"key":"2025091919345104800_usaf310-B31","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1007\/s12028-024-02048-5","article-title":"How to define and meet blood pressure targets after traumatic brain injury: a narrative review","volume":"41","author":"Kartal","year":"2024","journal-title":"Neurocrit Care"},{"key":"2025091919345104800_usaf310-B32","doi-asserted-by":"publisher","first-page":"QT3B","DOI":"10.55460\/QT3B-XK5B","article-title":"Tactical combat casualty care (TCCC) guidelines: 25 January 2024","volume":"13","author":"Deaton","year":"2024","journal-title":"J Spec Oper Med"},{"key":"2025091919345104800_usaf310-B33","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3390\/traumacare2010006","article-title":"The role of prehospital REBOA for hemorrhage control in civilian and military austere settings: a systematic review","volume":"2","author":"Chan","year":"2022","journal-title":"Trauma Care"},{"key":"2025091919345104800_usaf310-B34","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.annemergmed.2016.08.007","article-title":"The impact of combined prehospital hypotension and hypoxia on mortality in major traumatic brain injury","volume":"69","author":"Spaite","year":"2017","journal-title":"Ann Emerg Med"},{"key":"2025091919345104800_usaf310-B35","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.ajem.2022.12.015","article-title":"Correlation between prehospital and in-hospital hypotension and outcomes after traumatic brain injury","volume":"65","author":"Rice","year":"2023","journal-title":"Am J Emerg Med"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/686\/64288242\/usaf310.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/190\/Supplement_2\/686\/64288242\/usaf310.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T23:34:59Z","timestamp":1758324899000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/190\/Supplement_2\/686\/8256328"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,1]]},"references-count":35,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2025,9,16]]},"published-print":{"date-parts":[[2025,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf310","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,9]]},"published":{"date-parts":[[2025,9,1]]}}}