Raising Systemic Blood Pressure to Delay Irreversible Intestinal Ischemia in a Swine Model of Proximal Superior Mesenteric ArteryOcclusion

• Published in: The Journal of surgical research 2024-03, Vol.295, p.70
• Main Authors: Stonko, David P, Edwards, Joseph, Abdou, Hossam, Treffalls, Rebecca, Walker, Patrick, Morrison, Jonathan J
• Format: Article
• Language: English
• Subjects: Animals; Arterial Pressure; Blood Pressure; Ischemia - pathology; Mesenteric Artery, Superior - surgery; Mesenteric Ischemia - etiology; Mesenteric Ischemia - surgery; Norepinephrine; Swine
• ISSN: 1095-8673; 1095-8673
• DOI: 10.1016/j.jss.2023.09.076

Acute proximal superior mesenteric artery (SMA) occlusion is highly lethal, and adjuncts are needed to mitigate ischemic injury until definitive therapy. We hypothesized that raising mean arterial pressure (MAP) >90 mmHg with norepinephrine may delay irreversible bowel ischemia by increasing gastroduodenal artery (GDA) flow despite possible pressor-induced vasospasm. 12 anesthetized swine underwent laparotomy, GDA flow probe placement, and proximal SMA exposure and clamping. Animals were randomized between conventional therapy (CT) versus targeted MAP >90 mmHg (MAP push; MP) where norepinephrine was titrated after 45 min of SMA occlusion. Animals were followed until bowel death or 4 h. Kaplan-Meier bowel survival, mean normalized GDA flow, and histology were compared. 12 swine (mean 57.8 ± 7.6 kgs) were included, six per group. Baseline weight, HR, MAP and GDA flows were not different. Within 5 min following SMA clamping, all 12 animals had an increase in MAP without other intervention from 81.7 to 105.5 mmHg (29.1%, P