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Citation
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Cralley AL, Moore EE, Kissau D, Coleman JR, Vigneshwar N, DeBot M, Schaid TRJ, Moore HB, Cohen MJ, Hansen K, Silliman CC, Sauaia A, Fox CJ. J. Trauma Acute Care Surg. 2022; ePub(ePub): ePub. |
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Abstract
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INTRODUCTION: Improvised explosive devices (IEDs) have resulted in a unique polytrauma injury pattern termed Dismounted Complex Blast Injury (DCBI), which is frequent in the modern military theater. DCBI is characterized by extremity amputations, junctional vascular injury, and blast traumatic brain injury (bTBI). We developed a combat casualty relevant DCBI swine model, which combines hemorrhagic shock (HS) and tissue injury (TI) with a bTBI, to study interventions in this unique and devastating military injury pattern.
METHODS: 50 kg male Yorkshire swine were randomized to the DCBI or SHAM group (instrumentation only). Those in the DCBI group were subjected to HS, TI, and bTBI. The blast injury was applied using a 55 psi shock tube wave. TI was created with bilateral open femur fractures. HS was induced by bleeding from femoral arteries to target pressure. A resuscitation protocol modified from the Tactical Combat Casualty Care guidelines simulated battlefield resuscitation for 240 minutes.
RESULTS: Eight swine underwent the DCBI model and five were allocated to the SHAM group. In the DCBI model the mean base excess (BE) achieved at the end of the HS shock was -8.57 ± 5.13 mmol/L. A significant coagulopathy was detected in the DCBI model as measured by Prothrombin time (PT) (15.8 sec DCBI vs 12.86 sec SHAM, p = 0.02) and thromboelastography (TEG) maximum amplitude (MA) (68.5 mm DCBI vs 78.3 mm in SHAM, p = 0.0003). For the DCBI models, ICP increased by a mean 13 mmHg reaching a final ICP of 24 ± 7.7 mmHg.
CONCLUSIONS: We created a reproducible large animal model to study the combined effects of severe HS, TI, and bTBI on coagulation and intracranial pressure in the setting of DCBI, with significant translational applications for the care of military warfighters. Within the 4-hour observational period swine developed a consistent coagulopathy with a concurrent brain injury evidenced by increasing ICP. LEVEL OF EVIDENCE: N/A.
Language: en |