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Published in: World Journal of Surgery 10/2009

01-10-2009

Development of a Large Animal Model for Investigating Resuscitation After Blast and Hemorrhage

Authors: J. P. Garner, S. Watts, C. Parry, J. Bird, E. Kirkman

Published in: World Journal of Surgery | Issue 10/2009

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Abstract

Background

Blast injuries are an increasing problem owing to the widespread terrorist threat, but hemorrhage remains the second leading cause of civilian trauma death. Against this background, increasing numbers of prehospital and military trauma organizations are advocating a hypotensive approach to resuscitation of the hypovolemic casualty, deliberately aiming not to achieve a normal blood pressure so as not to disturb any newly formed blood clots at the site of a vascular injury.

Methods

There are no data available to guide clinicians as to how best to resuscitate the blast-injured casualty who has also suffered a hemorrhagic injury. A large-scale program was initiated to examine this question and to offer clinical guidance on the optimal resuscitation strategy in such circumstances in terms of volume, type of fluid, speed of resuscitation, and appropriate endpoints. Before such experiments could be undertaken, a novel large animal model of blast and hemorrhage had to be devised and validated. This study outlines the derivation of such a large animal model utilizing terminally anesthetized Large White pigs exposed to a standardized primary blast wave followed by a controlled hemorrhage of 30% of the total blood volume.

Results and conclusion

The preliminary results confirm the reliability and reproducibility of this model.
Literature
1.
2.
go back to reference Mellor SG, Cooper GJ (1989) Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–84: the Hostile Action Casualty System. Br J Surg 76(10):1006–1010PubMedCrossRef Mellor SG, Cooper GJ (1989) Analysis of 828 servicemen killed or injured by explosion in Northern Ireland 1970–84: the Hostile Action Casualty System. Br J Surg 76(10):1006–1010PubMedCrossRef
3.
go back to reference Leibovici D, Gofrit ON, Stein M et al (1996) Blast injuries: bus versus open-air bombings—a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 41(6):1030–1035PubMedCrossRef Leibovici D, Gofrit ON, Stein M et al (1996) Blast injuries: bus versus open-air bombings—a comparative study of injuries in survivors of open-air versus confined-space explosions. J Trauma 41(6):1030–1035PubMedCrossRef
4.
go back to reference Marti M, Parron M, Baudraxler F et al (2006) Blast injuries from Madrid terrorist bombing attacks on March 11, 2004. Emerg Radiol 13(3):113–122PubMedCrossRef Marti M, Parron M, Baudraxler F et al (2006) Blast injuries from Madrid terrorist bombing attacks on March 11, 2004. Emerg Radiol 13(3):113–122PubMedCrossRef
5.
go back to reference Dearden P (2001) New blast weapons. J R Army Med Corps 147(1):80–86PubMed Dearden P (2001) New blast weapons. J R Army Med Corps 147(1):80–86PubMed
6.
go back to reference Cooper GJ, Maynard RL, Cross NL et al (1983) Casualties from terrorist bombings. J Trauma 23(11):955–967PubMedCrossRef Cooper GJ, Maynard RL, Cross NL et al (1983) Casualties from terrorist bombings. J Trauma 23(11):955–967PubMedCrossRef
7.
go back to reference Little RA, Marshall HW, Kirkman E (1989) Attenuation of the acute cardiovascular-responses to hemorrhage by tissue injury in the conscious rat. Q J Exp Physiol 74(6):825–833PubMed Little RA, Marshall HW, Kirkman E (1989) Attenuation of the acute cardiovascular-responses to hemorrhage by tissue injury in the conscious rat. Q J Exp Physiol 74(6):825–833PubMed
8.
go back to reference Ohnishi M, Kirkman E, Guy RJ et al (2001) Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat. Exp Physiol 86(3):357–364PubMedCrossRef Ohnishi M, Kirkman E, Guy RJ et al (2001) Reflex nature of the cardiorespiratory response to primary thoracic blast injury in the anaesthetised rat. Exp Physiol 86(3):357–364PubMedCrossRef
9.
go back to reference Sawdon M, Ohnishi M, Watkins PE et al (2002) The effects of primary thoracic blast injury and morphine on the response to haemorrhage in the anaesthetised rat. Exp Physiol 87(6):683–689PubMedCrossRef Sawdon M, Ohnishi M, Watkins PE et al (2002) The effects of primary thoracic blast injury and morphine on the response to haemorrhage in the anaesthetised rat. Exp Physiol 87(6):683–689PubMedCrossRef
11.
go back to reference Clemedson CJ, Hultman HI (1954) Air embolism and the cause of death in blast injury. Mil Surgeon 114:424–437 Clemedson CJ, Hultman HI (1954) Air embolism and the cause of death in blast injury. Mil Surgeon 114:424–437
12.
go back to reference Benzinger T(1950) Physiologcal effects of blast in air and water. In: German aviation medicine in World War II. US Department of the Air Force, Washington, DC Benzinger T(1950) Physiologcal effects of blast in air and water. In: German aviation medicine in World War II. US Department of the Air Force, Washington, DC
13.
go back to reference Rossle R (1950) Pathology of blast effects. In: German aviation medicine in World War II. US Department of the Air Force, Washington, DC Rossle R (1950) Pathology of blast effects. In: German aviation medicine in World War II. US Department of the Air Force, Washington, DC
14.
go back to reference Yee ES, Verrier ED, Thomas AN (1983) Management of air embolism in blunt and penetrating thoracic trauma. J Thorac Cardiovasc Surg 85(5):661–668PubMed Yee ES, Verrier ED, Thomas AN (1983) Management of air embolism in blunt and penetrating thoracic trauma. J Thorac Cardiovasc Surg 85(5):661–668PubMed
15.
go back to reference American College of Surgeons Committee on Trauma (1997) Advanced Trauma Life Support Program for Doctors. American College of Surgeons, Chicago American College of Surgeons Committee on Trauma (1997) Advanced Trauma Life Support Program for Doctors. American College of Surgeons, Chicago
16.
go back to reference Bickell WH, Bruttig SP, Millnamow GA et al (1991) The detrimental effects of intravenous crystalloid after aortotomy in swine. Surgery 110(3):529–536PubMed Bickell WH, Bruttig SP, Millnamow GA et al (1991) The detrimental effects of intravenous crystalloid after aortotomy in swine. Surgery 110(3):529–536PubMed
17.
go back to reference Burris D, Rhee P, Kaufmann C et al (1999) Controlled resuscitation for uncontrolled hemorrhagic shock. J Trauma 46(2):216–223PubMedCrossRef Burris D, Rhee P, Kaufmann C et al (1999) Controlled resuscitation for uncontrolled hemorrhagic shock. J Trauma 46(2):216–223PubMedCrossRef
18.
go back to reference Solomonov E, Hirsh M, Yahiya A et al (2000) The effect of vigorous fluid resuscitation in uncontrolled hemorrhagic shock after massive splenic injury. Crit Care Med 28(3):749–754PubMedCrossRef Solomonov E, Hirsh M, Yahiya A et al (2000) The effect of vigorous fluid resuscitation in uncontrolled hemorrhagic shock after massive splenic injury. Crit Care Med 28(3):749–754PubMedCrossRef
19.
go back to reference Sondeen JL, Coppes VG, Holcomb JB (2003) Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma 54(5 Suppl):S110–S117PubMed Sondeen JL, Coppes VG, Holcomb JB (2003) Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma 54(5 Suppl):S110–S117PubMed
20.
go back to reference Bickell WH, Wall MJ Jr, Pepe PE et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331(17):1105–1109PubMedCrossRef Bickell WH, Wall MJ Jr, Pepe PE et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331(17):1105–1109PubMedCrossRef
21.
go back to reference Hodgetts TJ, Mahoney PE, Evans G et al (eds) (2006) Battlefield advanced life support. Defence Medical Education and Training Agency, UK Hodgetts TJ, Mahoney PE, Evans G et al (eds) (2006) Battlefield advanced life support. Defence Medical Education and Training Agency, UK
22.
go back to reference Holcomb JB (2003) Fluid resuscitation in modern combat casualty care: lessons learned from Somalia. J Trauma 54(5 Suppl):S46–S51PubMed Holcomb JB (2003) Fluid resuscitation in modern combat casualty care: lessons learned from Somalia. J Trauma 54(5 Suppl):S46–S51PubMed
23.
go back to reference Krausz MM (2003) Fluid resuscitation strategies in the Israeli army. J Trauma 54(5 Suppl):S39–S42PubMed Krausz MM (2003) Fluid resuscitation strategies in the Israeli army. J Trauma 54(5 Suppl):S39–S42PubMed
24.
go back to reference Place RJ, Rush RM Jr, Arrington ED (2003) Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation Enduring Freedom. Curr Surg 60(4):418–422PubMedCrossRef Place RJ, Rush RM Jr, Arrington ED (2003) Forward surgical team (FST) workload in a special operations environment: the 250th FST in Operation Enduring Freedom. Curr Surg 60(4):418–422PubMedCrossRef
25.
go back to reference Todd SR, Malinoski D, Muller PJ et al (2007) Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma 62(3):636–639PubMedCrossRef Todd SR, Malinoski D, Muller PJ et al (2007) Lactated Ringer’s is superior to normal saline in the resuscitation of uncontrolled hemorrhagic shock. J Trauma 62(3):636–639PubMedCrossRef
26.
go back to reference Kortbeek JB, Al Turki SA, Ali J et al (2008) Advanced trauma life support, 8th edition, the evidence for change. J Trauma 64(6):1638–1650PubMedCrossRef Kortbeek JB, Al Turki SA, Ali J et al (2008) Advanced trauma life support, 8th edition, the evidence for change. J Trauma 64(6):1638–1650PubMedCrossRef
27.
go back to reference Sapsford W, Watts S, Cooper G et al (2007) Recombinant activated factor VII increases survival time in a model of incompressible arterial hemorrhage in the anesthetized pig. J Trauma 62(4):868–879PubMedCrossRef Sapsford W, Watts S, Cooper G et al (2007) Recombinant activated factor VII increases survival time in a model of incompressible arterial hemorrhage in the anesthetized pig. J Trauma 62(4):868–879PubMedCrossRef
28.
go back to reference Cooper GJ, Jonsson A (1997) Protection against blast injury. In: Cooper GJ, Dudley HAF, Gann DS et al (eds) Scientific foundations of trauma. Butterworth-Heinemann, Oxford Cooper GJ, Jonsson A (1997) Protection against blast injury. In: Cooper GJ, Dudley HAF, Gann DS et al (eds) Scientific foundations of trauma. Butterworth-Heinemann, Oxford
29.
go back to reference Dronen SC, Stern SA, Wang X et al (1993) A comparison of the response of near-fatal acute hemorrhage models with and without a vascular injury to rapid volume expansion. Am J Emerg Med 11(4):331–335PubMedCrossRef Dronen SC, Stern SA, Wang X et al (1993) A comparison of the response of near-fatal acute hemorrhage models with and without a vascular injury to rapid volume expansion. Am J Emerg Med 11(4):331–335PubMedCrossRef
30.
go back to reference Bush JA, Jensen WN, Cartwright GE et al (1955) Blood volume studies in normal and anemic swine. Am J Physiol 181(9):14 Bush JA, Jensen WN, Cartwright GE et al (1955) Blood volume studies in normal and anemic swine. Am J Physiol 181(9):14
31.
go back to reference Barcroft H, Edholm OG, McMichael J et al (1944) Post haemorrhagic fainting: study by cardiac output and forearm blood flow. Lancet 1:489–491CrossRef Barcroft H, Edholm OG, McMichael J et al (1944) Post haemorrhagic fainting: study by cardiac output and forearm blood flow. Lancet 1:489–491CrossRef
32.
go back to reference Little RA, Randall PE, Redfern WS et al (1984) Components of injury (haemorrhage and tissue ischaemia) affecting cardiovascular reflexes in man and rat. Q J Exp Physiol 69(4):753–762PubMed Little RA, Randall PE, Redfern WS et al (1984) Components of injury (haemorrhage and tissue ischaemia) affecting cardiovascular reflexes in man and rat. Q J Exp Physiol 69(4):753–762PubMed
33.
go back to reference Evans RG, Ventura S, Dampney RA et al (2001) Neural mechanisms in the cardiovascular responses to acute central hypovolaemia. Clin Exp Pharmacol Physiol 28(5–6):479–487PubMedCrossRef Evans RG, Ventura S, Dampney RA et al (2001) Neural mechanisms in the cardiovascular responses to acute central hypovolaemia. Clin Exp Pharmacol Physiol 28(5–6):479–487PubMedCrossRef
34.
go back to reference Hannon JP, Bossone CA, Rodkey WG (1985) Splenic red cell sequestration and blood volume measurements in conscious pigs. Am J Physiol 248(3 Pt 2):R293–R301PubMed Hannon JP, Bossone CA, Rodkey WG (1985) Splenic red cell sequestration and blood volume measurements in conscious pigs. Am J Physiol 248(3 Pt 2):R293–R301PubMed
35.
go back to reference Kowalenko T, Stern S, Dronen S et al (1992) Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma 33(3):349–353PubMedCrossRef Kowalenko T, Stern S, Dronen S et al (1992) Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma 33(3):349–353PubMedCrossRef
36.
go back to reference Bilski TR, Baker BC, Grove JR et al (2003) Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned. J Trauma 54(5):814–821PubMedCrossRef Bilski TR, Baker BC, Grove JR et al (2003) Battlefield casualties treated at Camp Rhino, Afghanistan: lessons learned. J Trauma 54(5):814–821PubMedCrossRef
37.
go back to reference Bohman HR, Stevens RA, Baker BC et al (2005) The US Navy’s forward resuscitative surgery system during operation Iraqi freedom. Mil Med 170(4):297–301PubMed Bohman HR, Stevens RA, Baker BC et al (2005) The US Navy’s forward resuscitative surgery system during operation Iraqi freedom. Mil Med 170(4):297–301PubMed
Metadata
Title
Development of a Large Animal Model for Investigating Resuscitation After Blast and Hemorrhage
Authors
J. P. Garner
S. Watts
C. Parry
J. Bird
E. Kirkman
Publication date
01-10-2009
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 10/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0105-4

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