Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury
Self-expanding foam improves survival following a lethal, exsanguinating iliac artery injury
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DOI：
10.1097/ta.0000000000000263
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发表时间：
2014-07-01
影响因子：
3.4
通讯作者：
King, David Richard
中科院分区：
文献类型：
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作者：
Rago, Adam;Duggan, Michael J.;King, David Richard
背景技术背景：不可压缩的腹部出血是战场和平民环境中可预防死亡的重要原因，在受伤点没有有效的治疗方法。我们以前报道过，自膨式聚氨酯泡沫显著提高了致死性肝门静脉损伤大出血模型的存活率。在这项研究中，我们假设，泡沫治疗可以提高生存在一个致命的髂动脉损伤模型noncoagulopathic猪.METHODS：在猪与一个封闭的腹部，髂动脉横切，造成大量的不可压缩放血。损伤后，动物单独接受损伤控制液体复苏（n = 14）或除液体外还接受泡沫治疗。两个剂量的泡沫治疗进行了研究：100毫升（n = 12）和120毫升（n = 13）;所有动物进行监测3小时或直至death.RESULTS：泡沫治疗在两个剂量导致一个显着的生存效益和减少出血率相对于对照组。120 mL和100 mL剂量组的中位生存时间分别为135分钟和175分钟，而对照组为32分钟（两组p < 0.001）。泡沫导致平均动脉压立即、持续改善和腹内压一过性升高。120 mL组和100 mL组的中位出血率分别为0.27 g/kg/min和0.23 g/kg/min，而对照组为1.4 g/kg/min（与对照组相比，p值分别为0.003和0.006）。自膨胀泡沫治疗显著提高了其他致命的，不可压缩的，巨大的动脉损伤的生存率。这种治疗可以提供院前干预控制不可压缩的腹部出血。版权所有（C）2014由Lippincott威廉姆斯& Wilkins
BACKGROUND: Noncompressible abdominal bleeding is a significant cause of preventable death oft the battlefield and in the civilian setting, with no effective therapies available at point of injury. We previously reported that a self-expanding polyurethane foam significantly improved survival in a lethal hepatoportal injury model of massive venous hemorrhage. In this study, we hypothesized that foam treatment could improve survival in a lethal iliac, artery injury model in noncoagulopathic swine.METHODS: In swine with a closed abdomen, an iliac artery transection was created, resulting in massive noncompressible exsanguination. After injury, animals were treated with damage-control fluid resuscitation alone (n = 14) or foam treatment in addition to fluids. Two doses of foam treatment were studied: 100 mL (n = 12) and 120 mL (n = 13); all animals were monitored for 3 hours or until death.RESULTS: Foam treatment at both doses resulted in a significant survival benefit and reduction in hemorrhage rate relative to the control group. Median survival time was 135 minutes and 175 minutes for the 120-mL and 100-mL doses, compared with 32 minutes in the control group (p < 0.001 for both groups). Foam resulted in an immediate, persistent improvement in mean arterial pressure and a transient increase in intra-abdominal pressure. The median hemorrhage rate was 0.27 g/kg per minute in the 120-mL group and 0.23 g/kg per minute in the 100-mL group, compared with 1.4 g/kg per minute in the control group (p = 0.003 and 0.006, respectively, as compared with the control).CONCLUSION: Self-expanding foam treatment significantly improves survival in an otherwise lethal, noncompressible, massive, arterial injury. This treatment may provide a prehospital intervention for control of noncompressible abdominal hemorrhage. Copyright (C) 2014 by Lippincott Williams & Wilkins