Research

As part of the Jobst Vascular Research Laboratory, the Eliason team brings problems and questions observed in our clinical work with patients with vascular trauma to the lab bench. Our colleagues, experts in large animal model research and molecular techniques, help shape our investigations. The collaborative spirit and synergies inherent in the Jobst Lab and across the University of Michigan Medical School are critical to moving the field forward.

Motivating our scientific investigations is the need for a greater understanding of the pathways and mechanisms involved in hemorrhagic shock. Also driving our work is the need to balance the need for hemorrhage control with the ischemic complications that arise when a device is used to halt bleeding.

We use a range of animal models and molecular and morphomic analytical techniques to study vascular trauma. For example, we look at many parameters of bleeding, including geospatial correlation between the skeletal structure and vasculature, in order to detect and reduce vascular injury and improve hemorrhage control.

We also study REBOA use for hemorrhage control. More specifically we use our preclinical models to learn how to optimize balloon occlusion, since we have shown that the duration of REBOA use can impact complications and outcomes. Newer research is focused on partial REBOA to minimize the injuries that can occur when a major blood vessel has flow interrupted by a device.

Work on the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) has shown that REBOA can be life-saving in the face of hemorrhagic shock. Prolonged occlusion, defined as one hour, however, led to evidence of markers of kidney and liver damage and spinal cord injury that were not observed after 30 minutes. We also have found in animal models that traumatic brain injury can worsen complications and outcomes after prolonged REBOA use, again defined as one hour, for traumatic hemorrhage.

Work to use CT imaging and morphomic analysis to correlate skeletal features with the vasculature is providing new information to aid the insertion of the REBOA catheter in situations where image guidance is not available.

The synergy between Dr. Eliason's longtime scientific and clinical interest in hemorrhage control has had direct clinical impacts. REBOA now is used in many level 1 trauma centers in the United States. In addition, the U.S. military has added REBOA to its clinical practice guidelines (CPG) for hemorrhage control. Better understanding the physiologic impact of balloon occlusion that occurs for too long can help guide the use of REBOA technology to maximize the benefits for patients and minimize harms. Clinicians are now looking at REBOA use for hemorrhage due to causes other than blunt trauma, such as during childbirth in women with placenta accreta. The feasibility of pre-hospital REBOA is even being explored in the setting of non-traumatic out-of-hospital cardiac arrest. Work using morphomic analysis to correlate bony landmarks with vascular anatomy can help to guide REBOA catheter insertion, particularly in austere environments that lack imaging-guidance capabilities. This work can also help identify traumatic injury patterns most likely to result in vascular trauma and hemorrhage, leading to earlier detection and treatment to prevent hemorrhagic shock.

Our team is excited to explore other potential applications for REBOA, including during childbirth, as well as related technologies. For example, Dr. Kevin Ward of Emergency Medicine and Biomedical Engineering, is looking at the use of gastroesophageal resuscitative occlusion of the aorta, or GROA. In REBOA, the femoral artery is used to insert the catheter and block the aorta; GROA uses the esophagus for insertion and compresses and blocks the aorta from inside the stomach. These types of collaborative research efforts are very valuable to compare and contrast these types of invasive but potentially life-saving therapies. The study of partial REBOA is also of great interest, in an attempt to make a promising therapy even safer for patient use.

Within the Jobst Vascular Research Laboratory, we work closely with Dr. Dan Myers, PhD, on animal model investigations and molecular techniques. Other collaborations include:

• Innovative hemorrhage control work with Dr. Kevin Ward of the departments of Emergency Medicine and Biomedical Engineering to marry our understanding of hemorrhage control and device development.
• Research to understand the relationship between trauma and vascular injury with Dr. Stewart Wang, a pioneer in the area of analytical morphomics. This work entails use of CT imaging to learn more about traumatic injury patterns and to gain a greater geospatial understanding of the skeletal and vascular anatomy.
• With Dr. Hasan Alam, a renowned trauma surgeon-scientist, on the impact of traumatic brain injury and REBOA use.
• With Dr. Dawn Coleman and Abhijit Ghosh, we have a clinical research collaboration related to pediatric aortic and renal vascular diseases, including renovascular hypertension, abdominal aortic coarctation and mid-aortic syndrome.