Effects of Splenectomy in a Pre/Early Hospital Model of Traumatic Hemorrhage in Swine
Abstract
The leading cause of death in military casualties is hemorrhage and most of these deaths occur prior to arrival at a medical treatment facility. Previously, we used a swine polytrauma model consisting of lung contusion, laparotomy, liver laceration, and 24 ml/kg controlled hemorrhage to test treatments to improve coagulopathy, inflammation, and organ function over the first ~14 h after injury. Coagulopathy, inflammation, and organ damage were mild, despite 55% mortality, leaving little room for improvement by treatment. The spleen is involved in compensation (and maybe decompensation) in swine,asit is a large reservoir (and potential sink) of unstressed (i.e. non-hemodynamically active) blood volume and cells. We hypothesized that splenectomy prior to polytrauma might give our model greater organ damage and coagulopathy, with less mortality due to decompensation. Methods: We compared mortality, coagulopathy, hemodynamics, and inflammatory mediators (organ damage to follow) in a pilot study of swine polytrauma with splenectomy (SPL group; N = 9) to historical control data (CONT; N = 11). Results: Total blood removal, including blood drained from the excised spleen, was 30 ml/kg in SPL group, compared to 27 ml/kg in the CONT group. Despite this increase, mortality in the SPL group was reduced to 11% (p=0.04 vs CONT). Liver re-bleeding was unchanged. Though equivalent by the end of shock, SPL subjects elevated heart rates faster in response to hemorrhage than CONT. SPL subjects maintained a higher mean arterial pressure (MAP) than CONT subjects from end of shock through 5 h post-injury, though diastolic pressure (reflective of vascular compensation) stayed elevated compared to CONT through 11 h post-injury. In contrast, surviving CONT subjects maintained their MAP by increasing pulse pressure, suggesting greater cardiac effort. Resuscitation was completed in 1 h in theCONT group, whereas at 5.5 h resuscitation was still only 90% complete on average in the SPL group.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 29, 2019
- Accession Number
- AD1083301
Entities
People
- Alexander H. Penn
- Antonio Sanchez
- Chester J. Hutcheson
- Michael Falabella
- Orlando Hernandez
Organizations
- 59th Medical Wing