Intraoperative Acoustic Hemostasis

术中声波止血

• 批准号: 7905230
• 负责人: LAWRENCE A CRUM
• 金额: $ 35.76万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-31 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7905230
• 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; Detection; Devices; Dorsal; Emergency Situation; Engineering; Environment; Family suidae; Focused Ultrasound Therapy; Foundations; Funding; Goals; Hand; Hemorrhage; Hemostatic function; Hepatic; Hospitals; Human; Image; Individual; Injury; Joints; Lead; Life; Liver; Location; Methodology; Military Personnel; Modeling; Operating Rooms; Operative Surgical Procedures; Organ; Outcome; Patient Transfer; Patients; Pelvis; Physicians; Protocols documentation; Research; Research Personnel; Retroperitoneal Space; Site; Solid; Surface; System; Techniques; Technology; Therapeutic; Time; Trauma; Ultrasonography; Work; clinically relevant; combat; direct application; emergency service responder; experience; hemodynamics; imaging modality; improved; in vivo; intraoperative imaging; killings; meetings; mortality; oligomycin sensitivity-conferring protein; programs; research study; standard of care; 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岁以下个体死亡率的主要原因，并且在军事战斗中丧生的人中有很大一部分，而解剖是创伤死亡率的主要原因。威胁生命的出血既出现在固体器官的大量出血中（例如，Aast-Ois级IV级和V复杂的肝损伤），以及难以进入的地区出血（尤其是骨盆区域）。通过我们的初步工作，我们已经证明了高强度集中超声（HIFU）在动物模型中诱导血管和器官出血止血的潜力。 Ultrasound还提供了一种有用且高度发达的成像方式，该模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特定的装置和术中大量出血的方法，尤其是AAST-OIS IV级IV和V复杂的肝损伤，它们具有很高的死亡率，并且在骨盆区域患有严重伤口。当前严重肝损伤的临床方法是打包伤口，直到达到血液动力学稳定性，然后将患者转移到进行受损血管血管造影的血管造影套件中。由于无法在手术室进行血管造影，因此在此转移中浪费了宝贵的时间。我们在动物模型中拥有相当大的初步数据，这些数据表明，可以使用图像引导的HIFU设备在伤口部位诱导止血，或者遮挡手术室范围内，并在手术室的范围内掩盖供应出血部位的容器，从而消除了血管造血的需求，以及/或大量的手术手术。我们的建议描述了要实现这一激动人心的目标需要完成的四个一般任务：（1）利用超声对比剂来改善出血检测； （2）开发超声技术和协议，以检测出血位点的检测，定位和靶向； （3）开发一个集成图像引导的HIFU治疗系统； （4）在猪模型上进行体内实验，以证明图像引导的术中术中声学止血的能力。最后，该领域的进展将为这项研究的最终目标提供牢固的基础，该研究是由完全自动化的，便携式，图像引导的经脑止血装置的基础，该设备可以在平民创伤伤害中被第一反应者使用。