measuring-cardiac-output-in-a-swine-model

Measuring Cardiac Output in a Swine Model

Swine are frequently used in medical research given their similar cardiac physiology to that of humans. Measuring cardiac parameters such as stroke volume ...

development-selective-aortic-arch-perfusion-system-porcine-model

Development of a Selective Aortic Arch Perfusion System in a Porcine Model of Exsanguination Cardiac Arrest

Hemorrhage constitutes the majority of potentially preventable deaths from trauma. There is growing interest in endovascular resuscitation techniques such ...

R Adams Cowley Shock Trauma Center

University of Maryland Medical System

Traumatic abdominal injury is associated with significant mortality, especially in hemodynamically unstable patients. Trauma management now supports more conservative surgical management with judicious non-operative management. The aim of this study is to use STAG data to characterize abdominal trauma outcomes, focusing on factors that may influence mortality.

Outcomes following abdominal trauma in Scotland.

Endovascular techniques in trauma surgery are becoming increasingly important in patient management, with procedures such as pelvic and splenic angioembolization becoming the standard of care for certain injuries. Traditionally, such interventions are performed via femoral access, although the morbidity of this approach is not insignificant (3%-10%). Transradial access (TRA) is an attractive alternative, pioneered by cardiologists, with low rates of access site complications in patients undergoing coronary intervention. Recently, this technology has extended to other interventions. The aim of this study was to present the initial experience of a radial program in a busy trauma center, with specific regard to safety and complications.

Safety and efficacy of radial access in trauma in 65 trauma endovascular cases.

The study compared transradial access (TRA) and transfemoral access (TFA) for splenic angio-embolisation (SAE), with a focus on technical success, intra-operative adjuncts, and complications.

A Comparison of Transradial and Transfemoral Access for Splenic Angio-Embolisation in Trauma: A Single Centre Experience.

Mesenteric vascular disease carries a high risk of mortality and morbidity; however, due to obscure clinical presentation, it can be under-recognized. Currently, epidemiology of mesenteric vascular disease remains poorly defined. The aim of this study is to analyze changes in Scottish mortality rates from mesenteric vascular disease overtime.

Mesenteric vascular disease: A population-based cohort study.

Response to Re "A Comparison of Transradial and Transfemoral Access for Splenic Angio-Embolisation in Trauma: A Single Centre Experience".

The majority of endovascular interventions for trauma are performed using transfemoral access (TFA). Transradial access (TRA) is a recently integrated alternative at the authors' institution. This noninferiority study compares the technical success and complication rate of TRA compared with TFA.

Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study.

Authors' Reply: Weighing the pros and cons of radial access for the endovascular management of trauma patients: Response to rebuttal.

The emerging concept of endovascular resuscitation applies catheter-based techniques in the management of patients in shock to manipulate physiology, optimize hemodynamics, and bridge to definitive care. These interventions hope to address an unmet need in the care of severely injured patients, or those with refractory non-traumatic cardiac arrest, who were previously deemed non-survivable. These evolving techniques include Resuscitative Endovascular Balloon Occlusion of Aorta, Selective Aortic Arch Perfusion, and Extracorporeal Membrane Oxygenation and there is a growing literature base behind them. This review presents the up-to-date techniques and interventions, along with their application, evidence base, and controversy within the new era of endovascular resuscitation.

State-of-the-Art Review-Endovascular Resuscitation.

Exsanguination leading to cardiac arrest is the terminal phase of uncontrolled hemorrhage. Resuscitative interventions have focused on preload and afterload support. Outcomes remain poor due to several factors but poor coronary perfusion undoubtedly plays a role. The aim of this study is to characterize the relationship between arterial pressure and flow during hemorrhage in an effort to better describe the terminal phases of exsanguination.Male swine weighing 60 kg to 80 kg underwent splenectomy and instrumentation followed by a logarithmic exsanguination until asystole. Changes in hemodynamic parameters over time were compared using one-way, repeated measures analysis of variance.Nine animals weighing 69 ± 15 kg were studied. Asystole occurred at 53 ± 13 min when 52 ± 11% of total blood volume has been shed. The greatest fall in mean hemodynamic indices were noted in the first 15 min: SBP (80-42 mm Hg, P = 0.02), left ventricular end-diastolic volume (94-52 mL, P = 0.04), cardiac output (4.8-2.4 L/min, P = 0.03), coronary perfusion pressure (57-30 mm Hg, P = 0.01), and stroke volume (60-25 mL, P = 0.02). This corresponds to the greatest rate of exsanguination. Organized cardiac activity was observed until asystole without arrythmias. Coronary flow was relatively preserved throughout the study, with a precipitous decline once mean arterial pressure was less than 20 mm Hg, leading to asystole.In this model, initial hemodynamic instability was due to preload failure, with asystole occurring relatively late, secondary to failure of coronary perfusion. Future resuscitative therapies need to directly address coronary perfusion failure if effective attempts are to be made to salvage these patients.

The Cardiac Physiology Underpinning Exsanguination Cardiac Arrest: Targets for Endovascular Resuscitation.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporize patients with infradiaphragmatic hemorrhage. Current guidelines advise < 30 min, to avoid ischemia/ reperfusion injury, whenever possible. The technique of partial REBOA (P-REBOA) has been developed to minimize the effects of distal ischemia. This study presents our clinical experience with P-REBOA, comparing outcomes to complete occlusion (C-REBOA).

A feasibility study of partial REBOA data in a high-volume trauma center.

Reply.

A Technique for Open Chest Selective Aortic Arch Perfusion.

Swine () are utilized broadly in research settings, given similarities to human vessel size and function; however, there are some important differences for clinicians to understand in order to interpret and perform translational research. This review article uses angiograms acquired in the course of a translational research program to present a description of the functional anatomy of the swine.

The functional vascular anatomy of the swine for research.

To evaluate the mean aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) observed during open cardiac massage (OCM) versus those obtained with selective aortic arch perfusion (SAAP) in post-mortem hypovolemic swine.

ArticleTotal : 2	Year
Publication title Cited by 12	2021
Publication title Cited by 5	2020

Article	Year
Outcomes following abdominal trauma in Scotland. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 31069413	2019
Safety and efficacy of radial access in trauma in 65 trauma endovascular cases. Journal of vascular surgery\| PubMed ID: 31611111	2020
A Comparison of Transradial and Transfemoral Access for Splenic Angio-Embolisation in Trauma: A Single Centre Experience. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\| PubMed ID: 31865031	2020
Mesenteric vascular disease: A population-based cohort study. Vascular\| PubMed ID: 32605533	2020
Response to Re "A Comparison of Transradial and Transfemoral Access for Splenic Angio-Embolisation in Trauma: A Single Centre Experience". European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery\| PubMed ID: 32753306	2021
Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study. The journal of trauma and acute care surgery\| PubMed ID: 32826737	2020
Authors' Reply: Weighing the pros and cons of radial access for the endovascular management of trauma patients: Response to rebuttal. The journal of trauma and acute care surgery\| PubMed ID: 32890351	2020
State-of-the-Art Review-Endovascular Resuscitation. Shock (Augusta, Ga.)\| PubMed ID: 32925603	2021
The Cardiac Physiology Underpinning Exsanguination Cardiac Arrest: Targets for Endovascular Resuscitation. Shock (Augusta, Ga.)\| PubMed ID: 33337788	2021
A feasibility study of partial REBOA data in a high-volume trauma center. European journal of trauma and emergency surgery : official publication of the European Trauma Society\| PubMed ID: 33399878	2021
Reply. Journal of vascular surgery\| PubMed ID: 33485497	2021
Reply. Journal of vascular surgery\| PubMed ID: 33485504	2021
A Technique for Open Chest Selective Aortic Arch Perfusion. The journal of trauma and acute care surgery\| PubMed ID: 33496546	2021
The functional vascular anatomy of the swine for research. Vascular\| PubMed ID: 33813971	2021
Selective aortic arch perfusion versus open cardiac massage in exsanguination cardiac arrest: A comparison of coronary pressure dynamics in swine. Resuscitation\| PubMed ID: 33857557	2021

Marta J. Madurska

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