Intraoperative Acoustic Hemostasis

术中声波止血

• 批准号: 7261068
• 负责人: LAWRENCE A CRUM
• 金额: $ 37.86万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7261068
• 关键词: Accounting; Acoustics; Age-Years; Angiography; Animal Model; Area; Arts; Basic Science; Blood Vessels; Blunt Trauma; Caring; Clinical; Contrast Media; Data; Department of Defense; Deposition; Depth; Detection; Devices; Dorsal; Emergency Situation; Engineering; Environment; Family suidae; Focused Ultrasound Therapy; Foundations; Funding; Goals; Hand; Hemorrhage; Hemostatic function; Hepatic; Hospitals; Image; Individual; Injury; Invasive; Joints; Lead; Life; Liver; Location; Methodology; Military Personnel; Modality; Modeling; Numbers; Operating Rooms; Operative Surgical Procedures; Organ; Outcome; Patient Transfer; Patients; Pelvis; Physicians; Protocols documentation; Range; Rate; Research; Research Personnel; Retroperitoneal Space; Site; Solid; Standards of Weights and Measures; Surface; System; Techniques; Technology; Therapeutic; Time; Trauma; Ultrasonography; Work; clinically relevant; direct application; emergency service responder; experience; hemodynamics; human study; improved; in vivo; intraoperative imaging; killings; mortality; oligomycin sensitivity-conferring protein; programs; research study; success; technology development; wound

DESCRIPTION (provided by applicant): Trauma is the major cause of mortality in individuals under 45 years of age and accounts for a large percentage of those killed in military combat, with exsanguination being the principal cause of trauma mortality. Life-threatening hemorrhages occur both in profuse bleeding from solid organs, (for example, AAST-OIS grades IV and V complex hepatic injuries), and from bleeding in regions that are difficult to access (particularly the pelvic area). Through our preliminary work, we have demonstrated the potential of High Intensity Focused Ultrasound (HIFU) to induce vascular and organ hemorrhage hemostasis in animal models. Ultrasound also provides a useful and highly-developed imaging modality that is in widespread use in a clinical environment. We propose to utilize both the imaging and therapeutic capabilities of ultrasound to develop a specific device and a methodology for the intraoperative treatment of profuse bleeding, particularly AAST-OIS grades IV and V complex hepatic injuries, which have a high mortality rate, and for severe wounds in the pelvic area. The current clinical approach to severe hepatic injuries is to pack the wounds until hemodynamic stability is achieved, and then to transfer the patient to the angiography suite where angioembolization of the damaged vessels is performed. Valuable time is lost in this transfer because angiography cannot be performed in the operating room. We have considerable preliminary data in animal models that suggests that an image-guided HIFU device could be used to induce hemostasis at the site of the wound, or to occlude the vessels supplying the bleeding site, immediately, and within the confines of the operating room, thus obviating the need for angioembolization, and/or significant operative maneuvers. Our proposal describes four general tasks that need to be accomplished to meet this exciting goal: (1) To utilize ultrasound contrast agents to improve bleeding detection; (2) To develop ultrasound techniques and protocols for detection, localization, and targeting of bleeding sites; (3) To develop an integrated image guided HIFU therapy system; and (4) To perform in vivo experiments on a porcine model to demonstrate the capabilities of image-guided intraoperative acoustic hemostasis. Finally, progress in this area would provide a firm foundation for the ultimate goal of this research-that of a fully automated, portable, image-guided transcutaneous acoustic hemostasis device that could be used by first responders in civilian trauma injuries.

描述（由申请人提供）：创伤是45岁以下个人死亡的主要原因，在军事战斗中死亡的人数中占很大比例，失血过多是创伤死亡的主要原因。危及生命的出血既发生在实体器官大量出血（例如，AAST-OIS分级IV级和V级复杂肝损伤），也发生在难以进入的区域出血（特别是骨盆区域）。通过我们的初步工作，我们已经证明了高强度聚焦超声（HIFU）在动物模型中诱导血管和器官出血止血的潜力。超声也提供了一种有用的和高度发达的成像方式，在临床环境中广泛使用。我们建议利用超声的成像和治疗能力来开发一种特定的设备和方法，用于术中治疗大量出血，特别是AAST-OIS IV级和V级复杂肝损伤，这具有很高的死亡率，以及骨盆区域的严重伤口。目前治疗严重肝损伤的临床方法是包扎伤口，直到血流动力学稳定，然后将患者转移到血管造像室，对受损血管进行血管栓塞。由于不能在手术室进行血管造影，因此在这种转移中浪费了宝贵的时间。我们在动物模型中有相当多的初步数据表明，在手术室范围内，图像引导的HIFU设备可用于在伤口部位诱导止血，或立即阻塞出血部位的血管，从而避免了血管栓塞和/或重大手术操作的需要。我们的提案描述了实现这一令人兴奋的目标需要完成的四个一般任务：(1)利用超声造影剂来提高出血检测；(2)发展超声检测、定位和定位出血部位的技术和方案；(3)开发集成图像引导HIFU治疗系统；(4)在猪模型上进行体内实验，以证明图像引导术中声学止血的能力。最后，该领域的进展将为本研究的最终目标提供坚实的基础，该目标是一种全自动、便携式、图像引导的经皮声学止血装置，可用于平民创伤损伤的急救人员。