A translational porcine model to assess the graded impact of hemorrhage and aortic occlusion on cardiovascular hemodynamics and renal perfusion

Mobin, F. U.; Gomez, M. K.; Januszko, S.; Dooley, J.; Renaldo, A. C.; Burkhart, H.; Jordan, J. E.; Williams, T. K.; Neff, L. P.; Sadid, S.; Eden, M. J.; Figueroa, C. A.; Rahbar, E.

doi:10.64898/2026.02.05.703869

bioRxiv · 10.64898/2026.02.05.703869

A translational porcine model to assess the graded impact of hemorrhage and aortic occlusion on cardiovascular hemodynamics and renal perfusion

Mobin, F. U.·Gomez, M. K.·Januszko, S.·Dooley, J.·Renaldo, A. C.·Burkhart, H.·Jordan, J. E.·Williams, T. K.·Neff, L. P.·Sadid, S.·Eden, M. J.·Figueroa, C. A.·Rahbar, E.

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Abstract

Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is a lifesaving intervention used to manage non-compressible torso hemorrhage by temporarily occluding the aorta to minimize blood loss and preserve perfusion to vital organs. Partial REBOA (p-REBOA) has been proposed to mitigate ischemic injury associated with full-REBOA (f-REBOA). However, implementation of p-REBOA clinically has been challenging due to our limited understanding of the acute hemodynamics with p-REBOA particularly in relation to cardiac, carotid, and renal perfusion. In this study we developed and utilized a novel porcine model to continuously measure cardiac, carotid, renal and systemic hemodynamic responses to varying degrees of hemorrhagic shock and aortic occlusion. Yorkshire pigs (N=54) underwent instrumentation for continuous hemodynamic monitoring and hemorrhage was induced for 30 minutes to achieve 10%, 20%, or 30% blood volume loss (n=18/group), followed by randomized treatments of either no occlusion, p-REBOA, or f-REBOA occlusion strategies (n=6/group) for 30 minutes. After occlusion, shed blood was re-transfused over 15 minutes, and REBOA balloons were deflated and removed. This was followed by a 3-hour automated resuscitation and critical care period. Renal and carotid perfusion decreased progressively with hemorrhage severity. Interestingly, 30 minutes of f-REBOA resulted in significant ischemia-reperfusion injury where renal perfusion was profoundly suppressed to 40% of baseline renal flow. On the other hand, p-REBOA yielded superior renal perfusion, while maintaining cardiac function and carotid perfusion. p-REBOA also required less fluid and vasopressors. This translational pig model offers new opportunities to assess acute cardiovascular hemodynamics during interventions for the management of hemorrhagic shock.

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Mobin, F. U., Gomez, M. K., Januszko, S., Dooley, J., Renaldo, A. C., Burkhart, H., Jordan, J. E., Williams, T. K., Neff, L. P., Sadid, S., Eden, M. J., Figueroa, C. A., Rahbar, E.. 2026-02-09. A translational porcine model to assess the graded impact of hemorrhage and aortic occlusion on cardiovascular hemodynamics and renal perfusion. https://doi.org/10.64898/2026.02.05.703869

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