Effects of Splenectomy in a Pre/Early Hospital Model of Traumatic Hemorrhage in Swine
59 MDW San Antonio United States
Pagination or Media Count:
Introduction The leading cause of death in military casualties is hemorrhage and most of these deaths occur prior to arrival at a medical treatment facility. Previously, we used a swine polytrauma model consisting of lung contusion, laparotomy, liver laceration, and 24 mlkg controlled hemorrhage to test treatments to improve coagulopathy, inflammation, and organ function over the first 14 h after injury. Coagulopathy, inflammation, and organ damage were mild, despite 55 mortality, leaving little room for improvement by treatment. The spleen is involved in compensation and maybe decompensation in swine, as it is a large reservoir and potential sink of unstressed i.e. non-hemodynamically active blood volume and cells. We hypothesized that splenectomy prior to polytrauma might give our model greater organ damage and coagulopathy, with less mortality due to decompensation. Methods We compared mortality, coagulopathy, hemodynamics, and inflammatory mediators organ damage to follow in a pilot study of swine polytrauma with splenectomy SPL group N 9 to historical control data CONT N 11. Results Total blood removal, including blood drained from the excised spleen, was 30 mlkg in SPL group, compared to 27 mlkg in the CONT group. Despite this increase, mortality in the SPL group was reduced to 11 p0.04 vs CONT. Liver re-bleeding was unchanged. Though equivalent by the end of shock, SPL subjects elevated heart rates faster in response to hemorrhage than CONT. SPL subjects maintained a higher mean arterial pressure MAP than CONT subjects from end of shock through 5 h post-injury, though diastolic pressure reflective of vascular compensation stayed elevated compared to CONT through 11 h post-injury. In contrast, surviving CONT subjects maintained their MAP by increasing pulse pressure, suggesting greater cardiac effort.
- Medicine and Medical Research