A novel model of highly lethal uncontrolled torso hemorrhage in swine

Anders J. Davidson, Rachel M. Russo, Sarah Ashley E. Ferencz, John Kevin Grayson, Timothy K. Williams, Joseph M Galante, Lucas P. Neff

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction A reproducible, lethal noncompressible torso hemorrhage model is important to civilian and military trauma research. Current large animal models balancing clinical applicability with standardization and internal validity. As such, large animal models of trauma vary widely in the surgical literature, limiting comparisons. Our aim was to create and validate a porcine model of uncontrolled hemorrhage that maximizes reproducibility and standardization. Methods Seven Yorkshire-cross swine were anesthetized, instrumented, and splenectomized. A simple liver tourniquet was applied before injury to prevent unregulated hemorrhage while creating a traumatic amputation of 30% of the liver. Release of the tourniquet and rapid abdominal closure following injury provided a standardized reference point for the onset and duration of uncontrolled hemorrhage. At the moment of death, the liver tourniquet was quickly reapplied to provide accurate quantification of intra-abdominal blood loss. Weight and volume of the resected and residual liver segments were measured. Hemodynamic parameters were recorded continuously throughout each experiment. Results This liver injury was rapidly and universally lethal (11.2 ± 4.9 min). The volume of hemorrhage (35.8% ± 6% of total blood volume) and severity of uncontrolled hemorrhage (100% of animals deteriorated to a sustained mean arterial pressure <35 mmHg for 5 min) were consistent across all animals. Use of the tourniquet effectively halted preprocedure and postprocedure blood loss allowing for accurate quantification of amount of hemorrhage over a defined period. In addition, the tourniquet facilitated the creation of a consistent liver resection weight (0.0043 ± 0.0003 liver resection weight: body weight) and as a percentage of total liver resection weight (27% ± 2.2%). Conclusions This novel tourniquet-assisted noncompressible torso hemorrhage model creates a standardized, reproducible, highly lethal, and clinically applicable injury in swine. Use of the tourniquet allowed for consistent liver injury and precise control over hemorrhage. Recorded blood loss was similar across all animals. Improving reproducibility and standardization has the potential to offer improvements in large animal translational models of hemorrhage. Level of Evidence Level I

Original languageEnglish (US)
Pages (from-to)306-315
Number of pages10
JournalJournal of Surgical Research
Volume218
DOIs
StatePublished - Oct 1 2017

Fingerprint

Torso
Tourniquets
Swine
Hemorrhage
Liver
Wounds and Injuries
Weights and Measures
Animal Models
Traumatic Amputation
Residual Volume
Blood Volume
Arterial Pressure
Hemodynamics
Body Weight

Keywords

  • Animal model
  • Hemorrhage
  • Liver injury
  • Resuscitation
  • Shock
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Davidson, A. J., Russo, R. M., Ferencz, S. A. E., Grayson, J. K., Williams, T. K., Galante, J. M., & Neff, L. P. (2017). A novel model of highly lethal uncontrolled torso hemorrhage in swine. Journal of Surgical Research, 218, 306-315. https://doi.org/10.1016/j.jss.2017.06.045

A novel model of highly lethal uncontrolled torso hemorrhage in swine. / Davidson, Anders J.; Russo, Rachel M.; Ferencz, Sarah Ashley E.; Grayson, John Kevin; Williams, Timothy K.; Galante, Joseph M; Neff, Lucas P.

In: Journal of Surgical Research, Vol. 218, 01.10.2017, p. 306-315.

Research output: Contribution to journalArticle

Davidson, AJ, Russo, RM, Ferencz, SAE, Grayson, JK, Williams, TK, Galante, JM & Neff, LP 2017, 'A novel model of highly lethal uncontrolled torso hemorrhage in swine', Journal of Surgical Research, vol. 218, pp. 306-315. https://doi.org/10.1016/j.jss.2017.06.045
Davidson, Anders J. ; Russo, Rachel M. ; Ferencz, Sarah Ashley E. ; Grayson, John Kevin ; Williams, Timothy K. ; Galante, Joseph M ; Neff, Lucas P. / A novel model of highly lethal uncontrolled torso hemorrhage in swine. In: Journal of Surgical Research. 2017 ; Vol. 218. pp. 306-315.
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abstract = "Introduction A reproducible, lethal noncompressible torso hemorrhage model is important to civilian and military trauma research. Current large animal models balancing clinical applicability with standardization and internal validity. As such, large animal models of trauma vary widely in the surgical literature, limiting comparisons. Our aim was to create and validate a porcine model of uncontrolled hemorrhage that maximizes reproducibility and standardization. Methods Seven Yorkshire-cross swine were anesthetized, instrumented, and splenectomized. A simple liver tourniquet was applied before injury to prevent unregulated hemorrhage while creating a traumatic amputation of 30{\%} of the liver. Release of the tourniquet and rapid abdominal closure following injury provided a standardized reference point for the onset and duration of uncontrolled hemorrhage. At the moment of death, the liver tourniquet was quickly reapplied to provide accurate quantification of intra-abdominal blood loss. Weight and volume of the resected and residual liver segments were measured. Hemodynamic parameters were recorded continuously throughout each experiment. Results This liver injury was rapidly and universally lethal (11.2 ± 4.9 min). The volume of hemorrhage (35.8{\%} ± 6{\%} of total blood volume) and severity of uncontrolled hemorrhage (100{\%} of animals deteriorated to a sustained mean arterial pressure <35 mmHg for 5 min) were consistent across all animals. Use of the tourniquet effectively halted preprocedure and postprocedure blood loss allowing for accurate quantification of amount of hemorrhage over a defined period. In addition, the tourniquet facilitated the creation of a consistent liver resection weight (0.0043 ± 0.0003 liver resection weight: body weight) and as a percentage of total liver resection weight (27{\%} ± 2.2{\%}). Conclusions This novel tourniquet-assisted noncompressible torso hemorrhage model creates a standardized, reproducible, highly lethal, and clinically applicable injury in swine. Use of the tourniquet allowed for consistent liver injury and precise control over hemorrhage. Recorded blood loss was similar across all animals. Improving reproducibility and standardization has the potential to offer improvements in large animal translational models of hemorrhage. Level of Evidence Level I",
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