Comparison of NIRS, serum biomarkers, and muscle damage in a porcine balloon compression model of acute compartment syndrome

Budsberg, Steven C.; Shuler, Michael S.; Hansen, M. Lock; Uhl, Elizabeth W.; Freedman, Brett A.

doi:10.1097/ta.0000000000001225

Cited by 18 publications

(22 citation statements)

References 28 publications

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“…This model showed an advanced method of pressure creation compared to the previous study. [28][29][30] In our study, there was a difference between the control pH of 31 P-MRS and the blood test. Especially at the ischemic state, ischemic tissue pH (6.5) from 31 P-MRS spectra was lower than arterial pH (7.4) from blood tests.…”

Section: Discussioncontrasting

confidence: 46%

“…However, CPK can be used as a useful biomarker to indicate the extent of muscle damage in the sub-acute phase. [28] Moreover, CPK has been used as a primary biomarker in recognizing trauma for patients with ACS. [16] In addition, a correlation between T2-weighted images signal intensity (Tibialis anterior & Gastrocnemius muscles regions) and CPK has been found.…”

Section: Discussionmentioning

confidence: 99%

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An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

Ohta

Hata

et al. 2021

Preprint

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IntroductionAcute compartment syndrome (ACS) leads to a series of health problems, limb salvage, disability, and even death. In vivo phosphorus-31 magnetic resonance spectroscopy (31P-MRS) provides a unique non-invasive method to assess skeletal muscle metabolisms such as inorganic phosphate (Pi), phosphocreatine (PCr), and adenosine triphosphate (ATP). The study aims to assess the ability of dynamic 31P-MRS in the early detection of muscular damage in ACS.Materials & MethodsThe study induced the fastened zip-tie model of ACS on normotensive Sprague-Dawley rats (n = 6). The spectra were acquired in Bruker 9.4-Tesla preclinical scanner using 1H/31P surface coil. 31P-MRS spectra and blood samples were obtained at time 0 (pre-ischemic phase) and every 15 minutes during the compression (120 minutes) and the reperfusion phase (90 minutes). 31P-MRS spectra findings were compared with plasma creatine phosphokinase (CPK).ResultsPCr/(Pi + PCr) ratio significantly decreased after muscle was compressed (P < 0.05). In contrast to this, CPK did not change significantly (P > 0.05). Both intracellular pH and arterial pH decreased over time. However, intracellular declined significantly (P < 0.05) at 60 minutes of ischemic state, and at 5 minutes and 60 minutes of reperfusion, while arterial pH slightly changed. After 30 minutes of ischemic, phosphomonoesters (PME) peak was detected, which was not seen at the pre-ischemic phase. It gradually increased and reached its highest peak at 120 minutes. At reperfusion state, 31P-MRS spectra and pH did not fully recover to their pre-ischemic state, and PME peak disappeared. There was a correlation between T2-weighted images and CPK from blood tests (R2 = 0.1996, P < 0.05).ConclusionsDynamic 31P-MRS technique is more clearly and rapidly detect the bioenergetic and mitochondrial functions change than blood test in a fastened zip-tie rat model of ACS. This technique is a promising non-invasive method to detect the early ischemic muscular damage in ACS.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

Ohta

Hata

et al. 2021

Preprint

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“…Three studies measured noninvasive or alternative means of measuring intracompartmental pressure. [ 33 , 35 , 37 ] However, prior research has demonstrated consistently poor diagnostic accuracy of compartment pressure measurements for detecting compartment syndrome in the clinical setting. As all these studies use correlation with intracompartmental pressure as their validation metric, it is unclear whether any of these diagnostic tools can provide additional utility toward compartment syndrome diagnosis in the clinical setting.…”

Section: Discussionmentioning

confidence: 99%

Animal models in compartment syndrome: a review of existing literature

O’Neill¹,

Boes²,

McCutcheon³

et al. 2022

OTA International: The Open Access Journal of Orthopaedic Trauma

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Objective: Extremity compartment syndrome (ECS) is a morbid condition resulting in permanent myoneural damage. Currently, the diagnosis of compartment syndrome relies on clinical symptoms and/or intracompartment pressure measurements, both of which are poor predictors of ECS. Animal models have been used to better define cellular mechanisms, diagnosis, and treatment of ECS. However, no standardized model exists. The purpose of this study was to identify existing animal research on extremity compartment syndrome to summarize the current state of the literature and to identify weaknesses that could be improved with additional research. Methods: A MEDLINE database search and reverse inclusion protocol were utilized. We included all animal models of ECS. Results: Forty-one studies were included. Dogs were the most commonly used model species, followed by pigs and rats. Most studies sought to better define the pathophysiology of compartment syndrome. Other studies evaluated experimental diagnostic modalities or potential treatments. The most common compartment syndrome model was intracompartment infusion, followed by tourniquet and intracompartment balloon models. Few models incorporated additional soft tissue or osseous injury. Only 65.9% of the reviewed studies confirmed that their model created myoneural injury similar to extremity compartment syndrome. Conclusions: Study purpose, methodology, and outcome measures varied widely across included studies. A standardized definition for animal compartment syndrome would direct more consistent research in this field. Few animal models have investigated the pathophysiologic relationship between traumatic injury and the development of compartment syndrome. A validated, clinically relevant animal model of extremity compartment syndrome would spur improvement in diagnosis and therapeutic interventions.

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“…In a porcine model of ACS, near-infrared spectroscopy provided a reliable, sensitive measure of tissue oxygenation that directly correlated with a simulated increase in tibial compartmental pressure and a decrease in tibial intracompartmental perfusion pressure [51]. In 2007, a paediatric case report utilised NIRS in the diagnosis of ACS in a one month old infant, with a NIRS value of 15% in the involved limb versus 40–50% in the uninvolved limb [52].…”

Section: Introductionmentioning

confidence: 99%

Diagnosing acute compartment syndrome—where have we got to?

McMillan

Gardner

Schmidt

et al. 2019

International Orthopaedics (SICOT)

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PurposeAcute compartment syndrome is a condition whereby tissue ischaemia occurs due to increased pressure in a closed myofascial compartment. It is a surgical emergency, with rapid recognition and treatment—the keys to good outcomes.MethodsThe available literature on diagnostic aids was reviewed by one of the senior authors 15 years ago. Now, we have further reviewed the literature, to aim to ascertain what progress has been made.ResultsIn this review, we present the evidence around a variety of available diagnostic options when investigating a potential case of acute compartment syndrome, including those looking at pressure changes, localised oxygenation, perfusion, metabolic changes and available blood serum biomarkers.ConclusionsA significant amount of work has been put into developing modalities of diagnosis for acute compartment syndrome in the last 15 years. There is a lot of promising outcomes being reported; however, there is yet to be any conclusive evidence to suggest that they should be used over intracompartmental pressure measurement, which remains the gold standard. However, clinicians should be cognizant that compartment pressure monitoring lacks diagnostic specificity, and could lead to unnecessary fasciotomy when used as the sole criterion for diagnosis. Therefore, pressure monitoring is ideally used in situations where clinical suspicion is raised.

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Comparison of NIRS, serum biomarkers, and muscle damage in a porcine balloon compression model of acute compartment syndrome

Cited by 18 publications

References 28 publications

An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

An Early Detection of Acute Compartment Syndrome in Fastened Zip-Tie Rat Model Using Dynamic Phosphorous-31 Magnetic Resonance Spectroscopy at 9.4 Tesla

Animal models in compartment syndrome: a review of existing literature

Diagnosing acute compartment syndrome—where have we got to?

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