LAUSR

W e would like to thank the team from Madigan Army Medical Center for their interest in our recent publication. From the outset, we acknowledge that a rigorous peer review of the science is how we develop better and safer technologies to improve patient care. In light of this, we will respond to the statements put forward in their letter to the editor. We chose the model of pressure-based intermittent REBOA (iREBOA) because, at the time our study was conducted, only their first published was available. It indicated that a pressure-based deflation schedule for iREBOA may be superior to a time-based iREBOA deflation schedule. We concede their point that a different model may have produced a different result. However, the main purpose of our study was to highlight the hemodynamic fluctuations that occur with balloon deflation, regardless of whether a pressure-based or time-based schedule for balloon deflation is used. We doubt that a time-based deflation schedule would have resulted in dramatically different findings. As it turned out, the timing of rescue inflations in our study was so predictable that the need for them was almost like clockwork. As such, we feel that our findings still have merit. With respect to the severity of the injury and the preexperimental phase of the study, we have no major disagreement because these are common for many trauma resuscitation models. That being said, we do believe that, after overnight fasting and during an open abdominal surgical setup, it is reasonable to ensure that the animals remain euvolemic with intravenous fluids and that the hemodynamic consequences of inhaled anesthetics are mitigated to obtain a mean arterial pressure goal close to human hemodynamic physiology before initiating the study. We welcome comments regarding how we achieve partial REBOA (pREBOA). The Madigan group states that the ER-REBOA catheter is difficult to precisely titrate, and we have made the same observation multiple times in the past. This is one of the reasons we used a rotational inflation device with continuous manipulation by a provider to obtain greater titration of balloon volumes.