In Vivo Assessment of the Combat Ready Clamp to Control Junctional Hemorrhage in Swine
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND Junctional wounds and associated hemorrhage have become more common and more lethal in the current war. The Combat Ready Clamp CRoC has been developed and deployed for treating junctional hemorrhage on the battlefield. This study examined the efficacy of CRoC and its acute effects in an animal model. METHODS Anesthetized pigs n 6 were subjected to laparotomy, splenectomy, and abdominal closure. Next, coagulopathy was induced in animals by hemodilution and hypothermia. The left femoral artery was isolated, punctured 6-mm hole, and allowed to bleed for 15 seconds. The groin wound was packed with gauze, and a CRoC applied and tightened until hemorrhage stopped. It was kept in place for 1 hour treatment period and then released for another hour or less control-period if animal exsanguinated. Fluid resuscitation was administered, and vascular blood flow was examined by Doppler and CT scans. After death, local tissues were collected for histology. RESULTS CRoC generated 800 to 900 mm Hg pressure on the wounds, which stopped the hemorrhage and prevented rebleeding during the first hour in all animals. Blood loss was minimal e137 mL, and mean arterial pressure remained at or higher than the target level 65 mm Hg during this period. Removal of the clamp promptly led to rebleeding and exsanguination of five of six pigs during the second hour despite fluid resuscitation. Blood loss, survival, shock indices, and other measures were significantly p G 0.01 different between the two periods. Doppler tests and CT scans showed no blood flow in the proximal, distal, and collateral arteries of the clamped leg. Minor inflammation was seen on blood vessels endothelium and nerves. CONCLUSION CRoC functioned as an effective hemostatic adjunct for compression and control of groin hemorrhage.
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