Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

Aaron M. Williams; Umar F. Bhatti; Isabel S. Dennahy; Kiril Chtraklin; Panpan Chang; Nathan J. Graham; Basil M. Baccouche; Shalini Roy; Mohammed Harajli; Jing Zhou; Vahagn C. Nikolian; Qiufang Deng; Yuzi Tian; Baoling Liu; Yongqing Li; Gregory L. Hays; Julia L. Hays; Hasan B. Alam

doi:10.3791/58284

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Method Article

Complete and Partial Aortic Occlusion for the Treatment of Hemorrhagic Shock in Swine

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DOI:

10.3791/58284

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August 24th, 2018

Aaron M. Williams^*¹ , Umar F. Bhatti^*¹ , Isabel S. Dennahy¹ , Kiril Chtraklin¹ , Panpan Chang¹ , Nathan J. Graham¹ , Basil M. Baccouche¹ , Shalini Roy¹ , Mohammed Harajli¹ , Jing Zhou¹ , Vahagn C. Nikolian¹ , Qiufang Deng¹ , Yuzi Tian¹ , Baoling Liu¹ , Yongqing Li¹ , Gregory L. Hays¹^,² , Julia L. Hays¹^,² , Hasan B. Alam¹

¹Department of Surgery, University of Michigan, ²Hays Innovations

^* These authors contributed equally

Summary

Here, we present a protocol demonstrating a hemorrhagic shock model in swine that uses aortic occlusion as a bridge to definitive care in trauma. This model has application in testing a wide range of surgical and pharmacological therapeutic strategies.

Abstract

Hemorrhage remains the leading cause of preventable deaths in trauma. Endovascular management of non-compressible torso hemorrhage has been at the forefront of trauma care in recent years. Since complete aortic occlusion presents serious concerns, the concept of partial aortic occlusion has gained a growing attention. Here, we present a large animal model of hemorrhagic shock to investigate the effects of a novel partial aortic balloon occlusion catheter and compare it with a catheter that works on the principles of complete aortic occlusion. Swine are anesthetized and instrumented in order to conduct controlled fixed-volume hemorrhage, and hemodynamic and physiological parameters are monitored. Following hemorrhage, aortic balloon occlusion catheters are inserted and inflated in the supraceliac aorta for 60 min, during which the animals receive whole-blood resuscitation as 20% of the total blood volume (TBV). Following balloon deflation, the animals are monitored in a critical care setting for 4 h, during which they receive fluid resuscitation and vasopressors as needed. The partial aortic balloon occlusion demonstrated improved distal mean arterial pressures (MAPs) during the balloon inflation, decreased markers of ischemia, and decreased fluid resuscitation and vasopressor use. As swine physiology and homeostatic responses following hemorrhage have been well-documented and are like those in humans, a swine hemorrhagic shock model can be used to test various treatment strategies. In addition to treating hemorrhage, aortic balloon occlusion catheters have become popular for their role in cardiac arrest, cardiac and vascular surgery, and other high-risk elective surgical procedures.

Introduction

Hemorrhage continues to be the dominant cause of preventable deaths in patients undergoing traumatic events, accounting for 90% of trauma-related deaths in the military setting and 40% of post-traumatic deaths in the civilian population¹^,². Although direct pressure can treat compressible hemorrhage, non-compressible torso hemorrhage remains difficult to treat and can be lethal without prompt hemostatic control. The historical approach of resuscitative thoracotomy or laparotomy with aortic cross-clamping has proved to be extremely invasive³^,⁴. This inte....