A new survivable damage control model including hypothermia, hemodilution, and liver injury

Abstract

Background: The purpose of this article is to describe a new model of traumatic intra-cavitary hemorrhage in a hypothermic, hemodiluted liver injury model that incorporates damage control principles and allows for survival.

Materials and methods: Twenty swine underwent a standardized 35% blood volume hemorrhage followed by resuscitation. Ten animals sustained nonsurgical and 10 a surgical high-grade liver injury. In the surgical liver injury, damage control gauze packing was performed. No operative treatment was provided for the nonsurgical liver injury, which was designed to test the efficacy of systemic hemostatic agents. After a 15 min treatment phase, the abdominal cavity was closed, with the packing in place for the surgical injury, and all animals were resuscitated. Necropsy was performed at 48 h post-injury.

Results: At the time of liver injury, the animals were hemodiluted and hypothermic. Both injuries caused a 20% drop in the mean arterial pressure from baseline (P<0.001). Comparing baseline thromboelastography results with the results after hemodilution, hypothermia, and liver injury, a hypercoagulopathic state was observed. Mortality was 30% for both types of liver injury. The mean volume of intra-abdominal blood present at autopsy was similar for both types of liver injuries (202 ± 161 mL and 214 ± 203 mL, respectively).

Conclusion: A new model of traumatic intra-cavitary hemorrhage in a hypothermic, hemodiluted liver injury model with damage control that allows for survival has been described. The mortality rate of 30% allows for the comparison of therapeutic interventions that may lead to improved survival.