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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

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Open Access 01-12-2019 | Shock | Original research

Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock

Authors: Changmei Weng, Kai Lan, Tao Li, Liangchao Zhang, Jianmin Wang, Xinan Lai

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2019

Abstract

Background

Tourniquet is the most widely used and effective first-aid equipment for controlling hemorrhage of injured limb in battlefield. However, time-out application of tourniquets leads to ischemic-necrosis of skeletal muscles and ischemia-reperfusion injury. Regional hypothermia (RH) on wounded limb can relieve the injury on local tissue and distant organs. We aimed to investigate the protective effects of RH on rabbits’ limbs injured by a steel-ball combined with hemorrhagic-shock, and then employed tourniquet over-time, tried to identify the optimal treatment RH.

Methods

Thirty rabbits were randomly divided into 5 groups. All rabbits were anesthetized, intubated femoral artery and vein in right-hind limbs. Sham operation group (Sham): only femoral arteriovenous cannula in right-hind limb. None RH group (NRH): rabbits were intubated as Sham group, then the soft tissues of rabbits’ left-hinds were injured by a steel-ball shooting, and were exsanguinated until shock, then bundled with rubber tourniquets for 4 h. Three RH subgroups: rabbits were injured as mentioned above, the injured limbs were bundled with rubber tourniquets and treated with different temperature (5 ± 1 °C, 10 ± 1 °C, and 20 ± 1 °C, respectively) for 4 h. The injury severity of lung and regional muscle was assessed by histologic examination. Activity of adenosine triphosphatase (ATPase) and content of malondialdehyde (MDA) in muscle, inflammatory cytokines, myoglobin, creatine kinase-MM (CK-MM), Heme, Heme oxygenase 1 (HO-1), lactic acid (Lac), and lectrolyte ion in serum were detected.

Results

Following with RH treatment, the injury of lung and local muscle tissue was alleviated evidencing by mitigation of histopathological changes, significant decrease of water-content and MDA content, and increase of ATPase activity. Lower level of Lac, Potassium (K⁺), inflammatory cytokines, Heme, CK-MM, myoglobin content, and higher level of Calcium (Ca²⁺), HO-1 content were shown in RH treatment. 10 °C was the most effective RH to increase ATPase activity, and decrease MDA, myoglobin, CK-MM content.

Conclusion

Transient RH (4 h) had a “long-term mitigation effects” (continued for 6 h) on time-out application of tourniquet with the fluid resuscitation and core temperature maintenance, and the most effective temperature for reducing the side effects on tourniquet time-out application was 10 °C.

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Title: Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock
Authors: Changmei Weng
Kai Lan
Tao Li
Liangchao Zhang
Jianmin Wang
Xinan Lai
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Shock
Shock
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2019
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/s13049-019-0678-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Regional hypothermia attenuates secondary-injury caused by time-out application of tourniquets following limb fragments injury combined with hemorrhagic shock

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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