Pilot Study of a Novel Swine Model for Controlling Junctional Hemorrhage Using the iTClamp in Conjunction With Hemostatic Agents

Stuart, Sean; Zarow, Gregory J.; Walchak, Alexandra C; McLean, Julie; Roszko, Paul J D

doi:10.1093/milmed/usy337

Cited by 22 publications

(17 citation statements)

References 23 publications

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“…These ndings sharply contrasted with results generated with previous laboratory animal models that were given a compensatory stabilization period 14 . Therefore, to avoid decompensated hypotension before treatment, we ultimately selected the intervention point when MAP decreased by 30%.…”

Section: Discussioncontrasting

confidence: 95%

Efficacy of a new zeolite-based hemostatic gauze in a gunshot model of junctional femoral artery hemorrhage in swine

Wang

et al. 2020

Preprint

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Objective This work sought to 1) establish a reliable gunshot model of junctional femoral artery rupture in swine that accurately simulates field rescue conditions, and 2) use the gunshot model to compare the efficacy and ease of application of zeolite nanometer hemostatic gauze with other hemostatic materials, Methods 36 healthy landrace swine (body weight 50 ± 5 kg) were randomly divided into three groups which were treated with Combat Gauze (CG), FeiChuang hemostatic gauze (FG), or standard medical gauze (SG). A gunshot model of femoral artery hemorrhage in landrace swine was used with portable ultrasound to accurately position the wound. After the shooting, when mean arterial pressure (MAP) of swine decreased by at least 30% for 10 seconds, wounds were pressed with standard packing (39 g) of gauze materials for 3 minutes to stop bleeding, and then bandaged with pressure. Blood samples were taken 15 min before injury, then 10 min, 30 min, and 60 min after injury to determine hemodynamic, coagulation, and arterial blood gas indexes. Wound temperatures were taken at 5 min, 10 min, 30 min, and 60 min after injury, and survival times were recorded. Results The CG (11.15 ± 3.09 ml/kg) and FG (12.19 ± 3.5 ml/kg) groups had significantly less blood loss than the SG group (16.8 ± 5.14 ml/kg) (P = 0.04; P = 0.039, respectively). After gauze packing, bleeding in CG (5.85 ± 1.17 ml/kg) and FG (5.37 ± 0.93 ml/kg) groups remained significantly lower than that of SG group (6.93 ± 1.03 ml/kg) (P = 0.011; P = 0.003, respectively). Wound temperature rose with time for all groups (p = 0.000). The wound temperatures in the FG group and the CG group were significantly higher than that of the SG group, (p = 0.004 and 0.009, respectively). Survival rates and times were not significantly different among the three groups, though the FG group had the longest average survival time (SD 204.8 s), compared with SG group (SD 177.8 s) and CG (SD 187.5 s) groups. No significant differences in hemodynamics, blood gas, and coagulation were observed among the three groups. Conclusions The gunshot model of junctional femoral arterial hemorrhage guided by ultrasound had high accuracy for femoral arterial rupture by bullet wound, and provided consistent and reproducible field-simulation conditions for comparison of hemostatic materials. Feichuang zeolite hemostatic gauze effectively controlled bleeding without excessive heat, as found in other zeolite-based products. However, improvements to application technique, such as a packing device are needed to improve operating time.

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Section: Discussioncontrasting

confidence: 95%

Efficacy of a new zeolite-based hemostatic gauze in a gunshot model of junctional femoral artery hemorrhage in swine

Wang

et al. 2020

Preprint

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“…Exsanguinating hemorrhage is the leading cause of preventable causes of death in the combat setting and over one-third of those cases are due to extremity or junctional injuries [1]. Due to several factors including routine wear of body armor, judicious use of tourniquets for extremity hemorrhage,the mortality from truncal and peripheral-extremity hemorrhage has decreased relatively [2].…”

Section: Introductionmentioning

confidence: 99%

“…In order to control junctional bleeding and prevent deaths, development led to newly FDA-cleared junctional tourniquets and hemostatic agents [1,[5][6]]. To date, there have been lots of literature comparing the hemostatic properties of these devices and materials [2,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Establishment of a Gunshot Model of Junctional Femoral Artery Hemorrhage in Swine Under Ultrasonic Guidance

Zhang¹,

Guo²,

Wang³

et al. 2021

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Background: In a combat setting, uncontrolled junctional hemorrhage, which occur at the junction of the torso and appendages, constitutes a major source of potentially preventable deaths. A reliable gunshot swine model of junctional femoral artery rupture was established under ultrasonic guidance to accurately simulate field rescue conditions. Methods: Picco monitoring was instrumented for the anesthetized Landrace pigs, and the right femoral artery was located by portable ultrasound. The pistol bullet hit the right femoral artery along the direction of ultrasonic probe, resulting in the artery rupture. After 30 seconds of uncontrolled hemorrhage, ballistic was filled with Combat Gauze to stop bleeding in BT group (n=10). Combat Gauze (QuikClot) was used to stop bleeding when the mean arterial pressure (MAP) decreased by 30% in MD group (n=10). The sham-operated pigs (n=10) underwent the same anesthetic and surgical procedures, but neither shooting nor gauze filling therapy were performed. No liquid treatment was performed in the three groups throughout the experiment. Blood samples were taken 15 min before injury, then 10 min, 30 min, and 60 min after injury to determine hemodynamic, coagulation, and arterial blood gas indexes. Animals were then monitored for 180 minutes and surviving animals were killed. Results: Histologic anatomy indicated that the right femoral artery and vein were completely ruptured in all 20 swine of MD and BT groups. Eighteen pigs had associated proximal femur fractures and the other two had associated midshaft femur fractures. The entrance diameters of wound were 11.4 mm (SD=0.4), and the exits diameters were 26.4 mm (SD=5.8). The blood loss of pre-tamponade (4.97±2.47 mL/kg vs 18.26±3.47 mL/kg, P<0.001), pro-tamponade (4.58±1.49 mL/kg vs 7.20±1.99 mL/kg, P=0.004) and the total amount of bleeding (9.54±3.80 mL/kg vs 25.46±3.68 mL/kg, P<0.001) in MD group were more than those in BT group. There was statistic difference in the PT, PH, LAC of three groups (P=0.005, 0.004, and<0.001, respectively) and in the body temperature, PH, LAC of different time points (all P<0.001). There were differences in body temperature, PH, PT, LAC of MD group compared with BT and SHAM groups 60 minutes after injury (all P<0.0167). The survival time of MD group was shorter than that of BT group (P=0.029). Conclusion: We established a reliable gunshot model of junctional hemorrhage in swine, which had high accuracy for femoral arterial rupture under ultrasonic guidance and provided consistent and reproducible field-simulation conditions. In this junctional hemorrhage model, blood loss of 30 seconds free bleeding did not meet criteria for shock, and MAP decreased by 30% is a better choice to ensure the success of the shock model.Trial registration: Authorized by Institutional Animal Care and Use Committee in China (grant no. SC2019-06-013).

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“…Exsanguinating hemorrhage is the leading cause of preventable deaths in combat settings, and over one-third of those cases are due to extremity or junctional injuries [1]. Due to several factors including routine wear of body armor and judicious use of tourniquets for extremity hemorrhage, mortality rates associated with truncal and peripheral-extremity hemorrhage have relatively decreased [2].…”

Section: Introductionmentioning

confidence: 99%

“…Advanced hemostatic agents or junctional tourniquets applied to wounds that are not amenable to treatment with a routine tourniquet have become the focus of research. Novel junctional tourniquets and hemostatic agents have been developed and approved by regulators to control junctional bleeding and prevent deaths [1,[5][6]. Several studies have examined the hemostatic properties of these devices and materials [2,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Gunshot model of junctional femoral artery hemorrhage in swine under ultrasonic guidance

Zhang

Guo

Wang

et al. 2021

Preprint

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Background In a combat setting, uncontrolled junctional hemorrhage constitutes a major source of potentially preventable deaths. It is very important to establish a model of massive hemorrhage of gunshot wound at junction area which can simulate field rescue conditions. Methods Picco monitoring was instrumented for the anesthetized Landrace pigs, and the right femoral artery was located by portable ultrasound. The pistol bullet hit the right femoral artery, resulting in an artery rupture. After 30 seconds of uncontrolled hemorrhage, the ballistic wound was filled with combat gauze (QuikClot) to stop bleeding in the BT group (n = 10). Combat gauze was used to stop bleeding when the mean arterial pressure (MAP) decreased by 30% in the MD group (n = 10). The sham-operated pigs (n = 10) underwent the same anesthetic and surgical procedures, but neither shooting nor gauze filling therapy was performed. Blood samples were taken 15 min before injury, and then 10 min, 30 min, and 60 min after the injury. Results Histologic anatomy indicated that the right femoral artery and vein were completely ruptured in all 20 swine of MD and BT groups. The blood loss of pre-tamponade (4.97 ± 2.47 mL/kg vs 18.26 ± 3.47 mL/kg, P < 0.001), pro-tamponade (4.58 ± 1.49 mL/kg vs 7.20 ± 1.99 mL/kg, P = 0.004) and the total amount of bleeding (9.54 ± 3.80 mL/kg vs 25.46 ± 3.68 mL/kg, P < 0.001) in MD group were more than those in BT group. There were differences in body temperature, PH, PT, LAC of MD group compared with BT and SHAM groups 60 minutes after injury (all P < 0.0167). The survival time of MD group was shorter than that of BT group (P = 0.029). Conclusion We established a reliable gunshot model of junctional hemorrhage in swine, which had high accuracy for femoral arterial rupture under ultrasonic guidance and provided consistent and reproducible field-simulation conditions. In this junctional hemorrhage model, blood loss of 30-second free bleeding did not meet the criteria for shock. The MAP decrease of 30% emerged as a better predictor of a successful shock model.

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Pilot Study of a Novel Swine Model for Controlling Junctional Hemorrhage Using the iTClamp in Conjunction With Hemostatic Agents

Cited by 22 publications

References 23 publications

Efficacy of a new zeolite-based hemostatic gauze in a gunshot model of junctional femoral artery hemorrhage in swine

Efficacy of a new zeolite-based hemostatic gauze in a gunshot model of junctional femoral artery hemorrhage in swine

Establishment of a Gunshot Model of Junctional Femoral Artery Hemorrhage in Swine Under Ultrasonic Guidance

Gunshot model of junctional femoral artery hemorrhage in swine under ultrasonic guidance

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