Splenectomy Prevents Death from Decompensation in Hemorrhagic Shock in Swine
Abstract
Controversy exists on whether to perform a splenectomy in large animal models of hemorrhagic shock, as hemorrhage-induced splenic contraction returns erythrocytes into circulation. However, existing studies have not examined splenectomy in otherwise lethal models. We hypothesized that a failure to remain constricted may cause the spleen to act as a volume sink, increasing early mortality. We performed splenectomy in 9 swine (NoSpl) and subjected them to polytrauma and hemorrhage (1.5h shock, 12.5h resuscitation/observation) similar to a historical group of 14 swine (Spl). Survival was significantly improved to 89% (versus 43% in the Spl group, p=0.02) and the need for fluids was significantly slowed in the NoSpl group. Rapid crystalloid resuscitation in Spl animals caused erythrocyte, platelet, and plasma protein dilution that reverted in under 2h, suggesting the added fluid extravasated. Total oxygen delivery always exceeded consumption in both groups, suggesting oxygen was not a limiting factor. However, the hindlimb oxygen extraction ratio was higher in the Spl group and plasma glucose dropped significantly in the Spl but not the NoSpl group, suggesting a potential hyper-metabolic state in some tissues in the Spl group. Plasma sodium and potassium were also more disrupted in the Spl group. Inflammatory cytokines and leukocytes increased earlier in the NoSpl animals but were more resolved by 14h. Thromboelastography was similar between groups. Our findings identify the spleen as a weak point in compensation and support no splenectomy when studying early mortality from decompensation and splenectomy when studying late mortality from organ injury.
Document Details
- Document Type
- Technical Report
- Publication Date
- Nov 01, 2021
- Accession Number
- AD1151883
Entities
People
- Alexander H. Penn
- Antonio O. Sanchez
- Jack Hutchenson
- Kassandra Mcfadden
- Michael J. Falabella
- Orlando Hernandez
Organizations
- 59th Medical Wing