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Summary

Abstract

Introduction

Protocol

Representative Results

Discussion

Acknowledgements

Materials

References

Medicine

Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Published: August 24th, 2018

DOI:

10.3791/58284

1Department of Surgery, University of Michigan, 2Hays Innovations
* These authors contributed equally

Here, we present a protocol demonstrating a hemorrhagic shock model in swine that uses aortic occlusion as a bridge to definitive care in trauma. This model has application in testing a wide range of surgical and pharmacological therapeutic strategies.

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the forefront of trauma care in recent years. Since complete aortic occlusion presents serious concerns, the concept of partial aortic occlusion has gained a growing attention. Here, we present a large animal model of hemorrhagic shock to investigate the effects of a novel partial aortic balloon occlusion catheter and compare it with a catheter that works on the principles of complete aortic occlusion. Swine are anesthetized and instrumented in order to conduct controlled fixed-volume hemorrhage, and hemodynamic and physiological parameters are monitored. Following hemorrhage, aortic balloon occlusion catheters are inserted and inflated in the supraceliac aorta for 60 min, during which the animals receive whole-blood resuscitation as 20% of the total blood volume (TBV). Following balloon deflation, the animals are monitored in a critical care setting for 4 h, during which they receive fluid resuscitation and vasopressors as needed. The partial aortic balloon occlusion demonstrated improved distal mean arterial pressures (MAPs) during the balloon inflation, decreased markers of ischemia, and decreased fluid resuscitation and vasopressor use. As swine physiology and homeostatic responses following hemorrhage have been well-documented and are like those in humans, a swine hemorrhagic shock model can be used to test various treatment strategies. In addition to treating hemorrhage, aortic balloon occlusion catheters have become popular for their role in cardiac arrest, cardiac and vascular surgery, and other high-risk elective surgical procedures.

Hemorrhage continues to be the dominant cause of preventable deaths in patients undergoing traumatic events, accounting for 90% of trauma-related deaths in the military setting and 40% of post-traumatic deaths in the civilian population1,2. Although direct pressure can treat compressible hemorrhage, non-compressible torso hemorrhage remains difficult to treat and can be lethal without prompt hemostatic control. The historical approach of resuscitative thoracotomy or laparotomy with aortic cross-clamping has proved to be extremely invasive3,4. This inte....

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In conducting research using animals, the investigators adhered to the Animal Welfare Act Regulations and other Federal statutes relating to animals and experiments involving animals and the principles set forth in the current version of the Guide for Care and Use of Laboratory Animals of the National Research Council. This study protocol was approved by the University of Michigan Institutional Animal Care and Use Committee (IACUC). The experiments were conducted in compliance with all regulations and guidelines regardin.......

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Hemodynamic and Physiological Parameters:

The MAP decreased immediately after the hemorrhage (Figures 3A - 3D). During the balloon inflation phase, animals in the complete occlusion group experienced a higher proximal MAP compared to the animals in the partial occlusion group (Figures 3A and 3B). The average distal MAP during the balloon inflation was higher in the.......

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In this protocol, we highlighted a hemorrhagic shock model in swine. This model has been shown to be both reliable and reproducible16,17,18,19. Models similar to this have been employed in several scientific studies investigating the effects of hemorrhagic shock on animal physiology16,20. Furthermore, this model has also been used for t.......

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We would like to acknowledge Rachel O'Connell, and Jessica Lee for their assistance with the animal studies. We would also like to acknowledge Maj. General Harold Timboe, MD, MPH, U.S. Army (Ret.), who has been an advisor and mentor for this project.

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Name Company Catalog Number Comments
Yorkshire-Landrace Swine Michigan State University Veterinary Farm
Anesthesia: Telazol Pfizer Dose: 2-8 mg/kg; IM
Anti-cholinergic: Atropine Pfizer Dose: 1mg, IM
Anesthesia: Isoflurane Baxter Dose: 1-5%, INH
Betadine Humco
Alcohol 70% Humco NDC 0395-4202-28
Datex-Aespire Anesthesia Machine GE Healthcare 7900
Endotracheal tube DEE Veterinary 20170518 Appropriate size for animal (6.5 or 7.0F)
Laryngoscope Miller 85-0045
Stylet Hudson RCI 5-151--1
Jelco 20G IV Catheter Smiths Medical 4054
Operating Room Monitor (Vital Signs Monitor) SurgiVet Advisor V9201 May require at least 2
Surgical Gowns Kimberly Clark 90142 Use appropriate size for surgeon.
Sterile surgical gloves Cardinal Health (Allegiance) 22537-570 Use appropriate size for surgeon.
Cautery Pencil Medline ESPB 2000
Suction tubing Medline DYND50251
Sunction tip: Yankauer Medline DYND50130
Bovie Aaron 1250 Electrocautery Unit Bovie Medical Co. FL BOV-A1250U
Salpel Blade - Size #10 Cardinal Health (Allegiance) 32295-010
Scalpel Handle Martin 10-295-11
Debakey Forceps Roboz RS-7562
Weitlander Retractor Roboz RS-8612
Mayo Scissors Roboz RS-76870SC
Army-navy Retractor Teleflex 164715
Mixter Right-angle Forceps Teleflex 175073
5F (1.7 mm) 11 cm Insertion Sheath with 0.35" Guidewire Boston Scientific 16035-05B
8F (2.7 mm) 11 cm Insertion Sheath with 0.35'' Guidewire Boston Scientific 16035-08B
20G angled Introducer Needle Arrow AK-09903-S
14F (4.78 mm) 13 cm Insertion Sheath with 10F dilator Cook Medical G08024
2-0 Silk 18'' 45 cm Ethicon A185H
3-0 Vicryl 36'' 90 cm Ethicon J344H
3-0 Nylon 18'' 45 cm Ethicon 663G
4-0 Prolene 30'' 75 cm Ethicon 8831H
20 ml syringe Metronic/Covidien 8881512878
3 mL syringe Metronic/Covidien 1180300555
6 mL syringe Metronic/Covidien 1180600777
1000ml 0.9% Saline Baxter 2B1324X
Foley Catheter (18F 30 cc) Bard 0166V18S
Urinary Drainage Bag Bard 154002
9F 10 cm Insertion Sheath Arrow AK-09903-S
Swan-Ganz pulmonary artery catheter (8F) Edwards Lifesciences co. CA 746F8
Carotid Flow Probe System Transonic, Ithaca, NY 3, 4, or 6 mm probes
SABOT catheter Hayes Inc.
CODA balloon catheter Cook Medical 8379144
Ultrasound, M-Turbo SonoSite
Amplatz Stiff Guidewire (0.035 inch, 260 cm) Cook Medical G03460
Arterial Blood Gas Syringes Smiths Medical 4041-2
Arterial Blood Gas Analyzer Nova Biochemical ABL800
Masterflex Pump Cole Palmer HV-77921-75
Blood Collection Bags Terumo 1BBD606A
Macro IV drip set Hospira 12672-28
Pentobarbital Pfizer Dose: 100 mg/kg; IV
Eppendorf Tubes Sorenson 11590
50 cc conical tubes Falcon 352097
Formalin Fisherbrand 431121
Bair Hugger Normothermia System Arizant Healthcare, Inc.

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