A porcine model for evaluating the management of noncompressible torso hemorrhage

Joseph M. White, Jeremy W. Cannon, Adam Stannard, Jerry R. Spencer, Heather Hancock, Ken Williams, John S. Oh, Todd E. Rasmussen

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Noncompressible hemorrhage from central vascular injuries remains the leading cause of preventable death in modern combat. This report introduces a large animal model of noncompressible torso hemorrhage, which permits assessment of the various approaches to this problem. Methods: Yorkshire swine were anesthetized and monitoring devices for central aortic pressure, carotid flow, and intracerebral and transcutaneous brain oximetry were applied. Class IV hemorrhagic shock was induced through an iliac arterial injury and animals were subjected to different vascular control methods including thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and proximal endovascular balloon occlusion. After vascular control, the injury was shunted, and damage control resuscitation was continued. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked over a subsequent resuscitation period. Postmortem tissue analysis was performed to compare levels of acute ischemic injury between groups. Results: The protocol for animal preparation, hemorrhage volume, open surgical technique, and posthemorrhage resuscitation was developed using four animals. The endovascular approach was developed using two additional animals. After model development, treatment animals subsequently underwent noncompressible hemorrhage with thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and endovascular aortic occlusion. Premature death occurred in one animal in the direct vascular control group. Conclusion: This study presents a large animal model of class IV hemorrhagic shock from noncompressible hemorrhage, which permits comparison of various vascular control methods to address this challenging problem. Future studies using this model as the standard will allow further development of strategies for the management of noncompressible hemorrhage.

Original languageEnglish (US)
Pages (from-to)S131-S138
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume71
Issue numberSUPPL. 1
DOIs
StatePublished - Jul 1 2011

Fingerprint

Torso
Swine
Blood Vessels
Hemorrhage
Constriction
Resuscitation
Hemorrhagic Shock
Vascular System Injuries
Transcutaneous Blood Gas Monitoring
Thorax
Animal Models
Balloon Occlusion
Premature Mortality
Wounds and Injuries
Cause of Death
Arterial Pressure
Biomarkers
Equipment and Supplies
Control Groups
Brain

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

White, J. M., Cannon, J. W., Stannard, A., Spencer, J. R., Hancock, H., Williams, K., ... Rasmussen, T. E. (2011). A porcine model for evaluating the management of noncompressible torso hemorrhage. Journal of Trauma - Injury, Infection and Critical Care, 71(SUPPL. 1), S131-S138. https://doi.org/10.1097/TA.0b013e3182219302
White, Joseph M. ; Cannon, Jeremy W. ; Stannard, Adam ; Spencer, Jerry R. ; Hancock, Heather ; Williams, Ken ; Oh, John S. ; Rasmussen, Todd E. / A porcine model for evaluating the management of noncompressible torso hemorrhage. In: Journal of Trauma - Injury, Infection and Critical Care. 2011 ; Vol. 71, No. SUPPL. 1. pp. S131-S138.
@article{db53e05dda714d358896960ac236b225,
title = "A porcine model for evaluating the management of noncompressible torso hemorrhage",
abstract = "Background: Noncompressible hemorrhage from central vascular injuries remains the leading cause of preventable death in modern combat. This report introduces a large animal model of noncompressible torso hemorrhage, which permits assessment of the various approaches to this problem. Methods: Yorkshire swine were anesthetized and monitoring devices for central aortic pressure, carotid flow, and intracerebral and transcutaneous brain oximetry were applied. Class IV hemorrhagic shock was induced through an iliac arterial injury and animals were subjected to different vascular control methods including thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and proximal endovascular balloon occlusion. After vascular control, the injury was shunted, and damage control resuscitation was continued. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked over a subsequent resuscitation period. Postmortem tissue analysis was performed to compare levels of acute ischemic injury between groups. Results: The protocol for animal preparation, hemorrhage volume, open surgical technique, and posthemorrhage resuscitation was developed using four animals. The endovascular approach was developed using two additional animals. After model development, treatment animals subsequently underwent noncompressible hemorrhage with thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and endovascular aortic occlusion. Premature death occurred in one animal in the direct vascular control group. Conclusion: This study presents a large animal model of class IV hemorrhagic shock from noncompressible hemorrhage, which permits comparison of various vascular control methods to address this challenging problem. Future studies using this model as the standard will allow further development of strategies for the management of noncompressible hemorrhage.",
author = "White, {Joseph M.} and Cannon, {Jeremy W.} and Adam Stannard and Spencer, {Jerry R.} and Heather Hancock and Ken Williams and Oh, {John S.} and Rasmussen, {Todd E.}",
year = "2011",
month = "7",
day = "1",
doi = "10.1097/TA.0b013e3182219302",
language = "English (US)",
volume = "71",
pages = "S131--S138",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "SUPPL. 1",

}

White, JM, Cannon, JW, Stannard, A, Spencer, JR, Hancock, H, Williams, K, Oh, JS & Rasmussen, TE 2011, 'A porcine model for evaluating the management of noncompressible torso hemorrhage', Journal of Trauma - Injury, Infection and Critical Care, vol. 71, no. SUPPL. 1, pp. S131-S138. https://doi.org/10.1097/TA.0b013e3182219302

A porcine model for evaluating the management of noncompressible torso hemorrhage. / White, Joseph M.; Cannon, Jeremy W.; Stannard, Adam; Spencer, Jerry R.; Hancock, Heather; Williams, Ken; Oh, John S.; Rasmussen, Todd E.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 71, No. SUPPL. 1, 01.07.2011, p. S131-S138.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A porcine model for evaluating the management of noncompressible torso hemorrhage

AU - White, Joseph M.

AU - Cannon, Jeremy W.

AU - Stannard, Adam

AU - Spencer, Jerry R.

AU - Hancock, Heather

AU - Williams, Ken

AU - Oh, John S.

AU - Rasmussen, Todd E.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - Background: Noncompressible hemorrhage from central vascular injuries remains the leading cause of preventable death in modern combat. This report introduces a large animal model of noncompressible torso hemorrhage, which permits assessment of the various approaches to this problem. Methods: Yorkshire swine were anesthetized and monitoring devices for central aortic pressure, carotid flow, and intracerebral and transcutaneous brain oximetry were applied. Class IV hemorrhagic shock was induced through an iliac arterial injury and animals were subjected to different vascular control methods including thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and proximal endovascular balloon occlusion. After vascular control, the injury was shunted, and damage control resuscitation was continued. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked over a subsequent resuscitation period. Postmortem tissue analysis was performed to compare levels of acute ischemic injury between groups. Results: The protocol for animal preparation, hemorrhage volume, open surgical technique, and posthemorrhage resuscitation was developed using four animals. The endovascular approach was developed using two additional animals. After model development, treatment animals subsequently underwent noncompressible hemorrhage with thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and endovascular aortic occlusion. Premature death occurred in one animal in the direct vascular control group. Conclusion: This study presents a large animal model of class IV hemorrhagic shock from noncompressible hemorrhage, which permits comparison of various vascular control methods to address this challenging problem. Future studies using this model as the standard will allow further development of strategies for the management of noncompressible hemorrhage.

AB - Background: Noncompressible hemorrhage from central vascular injuries remains the leading cause of preventable death in modern combat. This report introduces a large animal model of noncompressible torso hemorrhage, which permits assessment of the various approaches to this problem. Methods: Yorkshire swine were anesthetized and monitoring devices for central aortic pressure, carotid flow, and intracerebral and transcutaneous brain oximetry were applied. Class IV hemorrhagic shock was induced through an iliac arterial injury and animals were subjected to different vascular control methods including thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and proximal endovascular balloon occlusion. After vascular control, the injury was shunted, and damage control resuscitation was continued. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked over a subsequent resuscitation period. Postmortem tissue analysis was performed to compare levels of acute ischemic injury between groups. Results: The protocol for animal preparation, hemorrhage volume, open surgical technique, and posthemorrhage resuscitation was developed using four animals. The endovascular approach was developed using two additional animals. After model development, treatment animals subsequently underwent noncompressible hemorrhage with thoracic aortic clamping, supraceliac aortic clamping, direct vascular control, and endovascular aortic occlusion. Premature death occurred in one animal in the direct vascular control group. Conclusion: This study presents a large animal model of class IV hemorrhagic shock from noncompressible hemorrhage, which permits comparison of various vascular control methods to address this challenging problem. Future studies using this model as the standard will allow further development of strategies for the management of noncompressible hemorrhage.

UR - http://www.scopus.com/inward/record.url?scp=79960414952&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79960414952&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182219302

DO - 10.1097/TA.0b013e3182219302

M3 - Article

C2 - 21795889

AN - SCOPUS:79960414952

VL - 71

SP - S131-S138

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - SUPPL. 1

ER -