TY - JOUR
T1 - Localized control of exsanguinating arterial hemorrhage
T2 - An experimental model
AU - Haick, M.
AU - Abilez, Oscar
AU - Johnson, Bonnie
AU - Xu, Chengpei
AU - Taylor, Charles
AU - Rich, Norman
AU - Zarins, Christopher
N1 - Funding Information:
This investigation was undertaken to develop a test bed for the Deep Bleeder Acoustic Coagulator (DBAC) project, funded by the Defense Advanced Research Projects Agency (DARPA). The goal of the DBAC project was to utilize transcutaneous high intensity focused ultrasound (HIFU) to control acute arterial bleeding and achieve hemostasis in battlefield arterial injuries. The effectiveness of HIFU was to be evaluated in a test bed which had focal arterial injuries with well-defined high and low bleeding rates, uncomplicated by hemorrhagic shock responses. In this study we describe an experimental arterial injury model which is suitable for this purpose.
PY - 2011/1/1
Y1 - 2011/1/1
N2 - To develop an arterial injury model for testing hemostatic devices at well-defined high and low bleeding rates.Material and method. A side-hole arterial injury was created in the carotid artery of sheep. Shed blood was collected in a jugular venous reservoir and bleeding rate at the site of arterial injury was controlled by regulating outflow resistance from the venous reservoir. Two models were studied: uncontrolled exsanguinating hemorrhage and bleeding at controlled rates with blood return to maintain hemodynamic stability. Transcutaneous Duplex ultrasound was used to characterize ultrasound signatures at various bleeding rates.Results. A 2.5 mm arterial side-hole resulted in exsanguinating hemorrhage with an initial bleeding rate of 400 ml/min which, without resuscitation, decreased to below 100 ml/min in 5 minutes. After 17 minutes, bleeding from the injury site stopped and the animal had lost 60% of total blood volume. Reinfusion of shed blood maintained normal hemodynamics and both high and low bleeding rates could be maintained without hemorrhagic shock. Bleeding rate at the arterial injury site was held at 395±78 ml/min for 8 minutes, 110±11 ml/min for 15 minutes, and 12±1 ml/min for 12 minutes. Doppler flow signatures at the site of injury were characterized by high peak and end-diastolic flow velocities at the bleeding site which varied with the rate of hemorrhage.Conclusion. We have developed a hemodynamically stable model of acute arterial injury which can be used to evaluate diagnostic and treatment methods focused on control of the arterial injury site.
AB - To develop an arterial injury model for testing hemostatic devices at well-defined high and low bleeding rates.Material and method. A side-hole arterial injury was created in the carotid artery of sheep. Shed blood was collected in a jugular venous reservoir and bleeding rate at the site of arterial injury was controlled by regulating outflow resistance from the venous reservoir. Two models were studied: uncontrolled exsanguinating hemorrhage and bleeding at controlled rates with blood return to maintain hemodynamic stability. Transcutaneous Duplex ultrasound was used to characterize ultrasound signatures at various bleeding rates.Results. A 2.5 mm arterial side-hole resulted in exsanguinating hemorrhage with an initial bleeding rate of 400 ml/min which, without resuscitation, decreased to below 100 ml/min in 5 minutes. After 17 minutes, bleeding from the injury site stopped and the animal had lost 60% of total blood volume. Reinfusion of shed blood maintained normal hemodynamics and both high and low bleeding rates could be maintained without hemorrhagic shock. Bleeding rate at the arterial injury site was held at 395±78 ml/min for 8 minutes, 110±11 ml/min for 15 minutes, and 12±1 ml/min for 12 minutes. Doppler flow signatures at the site of injury were characterized by high peak and end-diastolic flow velocities at the bleeding site which varied with the rate of hemorrhage.Conclusion. We have developed a hemodynamically stable model of acute arterial injury which can be used to evaluate diagnostic and treatment methods focused on control of the arterial injury site.
KW - Doppler ultrasound signature
KW - arterial hemorrhage rate
KW - arterial injury model
KW - bleeding rate
UR - http://www.scopus.com/inward/record.url?scp=79952832279&partnerID=8YFLogxK
U2 - 10.2478/v10035-011-0001-0
DO - 10.2478/v10035-011-0001-0
M3 - Article
C2 - 22166236
AN - SCOPUS:79952832279
SN - 0032-373X
VL - 83
SP - 1
EP - 9
JO - Polski Przeglad Chirurgiczny/ Polish Journal of Surgery
JF - Polski Przeglad Chirurgiczny/ Polish Journal of Surgery
IS - 1
ER -