Development of a Fatal Noncompressible Truncal Hemorrhage Model with Combined Hepatic and Portal Venous Injury in Normothermic Normovolemic Swine

Authors

Ujwal R. Yanala, University of Nebraska Medical Center, OmahaFollow
Jason M. Johanning, University of Nebraska Medical Center, OmahaFollow
Iraklis I. Pipinos, University of Nebraska Medical Center, OmahaFollow
Gustavo F. Larsen, University of Nebraska - LincolnFollow
William H. Velander, University of Nebraska-LincolnFollow
Mark A. Carlson, University of Nebraska Medical Center, OmahaFollow

Date of this Version

9-24-2014

Citation

PLoS ONE 9(9): e108293. doi:10.1371/journal.pone.0108293

Comments

The work is made available under the Creative Commons CC0 public domain dedication.

Abstract

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury types through a midline incision: 1) central stellate injury (N = 6); 2) excision of a portal vein branch distal to the main PV trunk (N = 6); or 3) hemi-transection of the left lateral lobe of the liver at its base (N = 10). The one-hour mortality of these injuries was 0, 82, and 40%, respectively; the final mean arterial pressure was 65, 24, and 30 mm Hg, respectively; and the final hemoglobin was 8.3, 2.3, and 3.6 g/dL, respectively. Hemi-transection of the left lateral lobe of the liver appeared to target our desired mortality rate better than the other injury mechanisms.