Technique Development for a Polytrauma Model to Study Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (P-REBOA) in Swine (Sus scrofa)
DAVID GRANT USAF MEDICAL CENTER TRAVIS AFB CA TRAVIS AFB
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Introduction A reproducible, lethal non-compressible torso hemorrhage NCTH model is of importance to civilian and military trauma research. Current large animal models fail to balance clinical applicability with standardization and internal validity. As such, large animal models of trauma vary widely in literature, limiting comparisons. Methods Yorkshire-cross swine were anesthetized, instrumented, and splenectomized. A simple liver tourniquet was applied prior to injury to prevent unregulated hemorrhage while creating a traumatic amputation of 30 of the liver. Release of the tourniquet and rapid abdominal closure following injury provided a standardized reference point for the onset and duration of uncontrolled hemorrhage. At the moment of death, the liver tourniquet was quickly reapplied to provide accurate quantification of intra-abdominal blood loss. Weight and volume of the resected and residual liver segments were measured. Hemodynamic parameters were recorded continuously throughout the experiment. Results This liver injury was rapidly and universally lethal 11.2 - 4.9 min. The volume of hemorrhage 35.8 6 of total blood volume, and severity of uncontrolled hemorrhage 100 of animals deteriorated to a sustained MAP35mmHg for 5 minutes were consistent across all animals. Use of the tourniquet effectively halted pre- and post- procedure blood loss allowing for accurate quantification of amount of hemorrhage over a defined period. Additionally, the tourniquet facilitated the creation of a consistent liver resection weight by body weight ratio 0.0043 - 0.0003 and as a percentage of total liver resection volume 27 - 2.2.Conclusion This novel tourniquet-assisted NCTH model creates a standardized, reproducible, highly lethal, and clinically applicable injury in swine. Use of the tourniquet allowed for consistent liver injury and precise control over hemorrhage.
- Anatomy and Physiology
- Medicine and Medical Research