Long-term Effects of Combat Ready Clamp Application to Control Junctional Hemorrhage in Swine
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Groin application of Combat Ready Clamp CRoC in pigs elicits an acute inflammation in underlying ischemic tissues. This study examined functional recovery of pigs hind legs following 2 hours of CRoC application. METHODS Left femoral arteries were isolated and injured in anesthetized pigs. Following 25 hemorrhage, CRoC was applied on the inguen for 2 hours n 6, and wounds were covered with combat gauze CG. Bleeding was treated in the control animals n 5 with CG only. Next, CRoC and CG were removed, arteries were repaired and reflowed, and animals were recovered. The legs mobility was scored daily, and their neuromuscular functions were measured on Days 7 and 14. Computed tomographic angiography and blood analysis were performed on Days 0, 2, 7, and 14. Pigs were then euthanized, and tissues were collected for histology. Umbilicus application of CRoC was also tested in four pilot experiments. RESULTS Inguinal application of CRoC with 524 T 12mmHg pressure occluded iliac arteries and collateral circulation. Following surgical repair, blood flow to the arteries was restored, and five of six CRoC-applied legs recovered full mobility within 9 days. Control-treated legs recovered full function in 3 days p 0.001. At 2 weeks, muscle strength of CRoC-applied legs was diminished p G 0.05 vs. baselines or controls. Injury biomarkers in the CRoC group increased several fold compared with the controls on Day 2 but returned to baseline afterward. Histologic changes were mostly mild and indicative of ischemia in the CRoC group. Umbilical application of CRoC required higher pressure 625 T 8 mm Hg and caused gross ischemic necrosis of lumbar muscles with significant disabilities. CONCLUSION Two-hour inguinal application of CRoC caused mild and reversible ischemic injuries, which delayed full recovery of the limb function by a few days.
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