Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults

Shock
Guang JinHasan B Alam

Abstract

Traumatic brain injury (TBI) and hemorrhagic shock (HS) are the leading causes of trauma-related mortality and morbidity. Combination of TBI and HS (TBI + HS) is highly lethal, and the optimal resuscitation strategy for this combined insult remains unclear. A critical limitation is the lack of suitable large animal models to test different treatment strategies. We have developed a clinically relevant large animal model of TBI + HS, which was used to evaluate the impact of different treatments on brain lesion size and associated edema. Yorkshire swine (42-50 kg) were instrumented to measure hemodynamic parameters and intracranial pressure. A computer-controlled cortical impact device was used to create a TBI through a 20-mm craniotomy: 15-mm cylindrical tip impactor at 4 m/s velocity, 100-ms dwell time, and 12-mm penetration depth. Volume-controlled hemorrhage was started (40% blood volume) concurrent with the TBI. After 2 h of shock, animals were randomized to one of three resuscitation groups (n = 5/group): (a) normal saline (NS); (b) 6% hetastarch, Hextend (Hex); and (c) fresh frozen plasma (FFP). Volumes of Hex and FFP matched the shed blood, whereas NS was three times the volume. After 6 h of postresuscitation monitoring, b...Continue Reading

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Citations

Dec 10, 2013·Shock·Ernest E MooreAnirban Banerjee
Aug 15, 2014·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Martin SillesenHasan B Alam
Jul 8, 2015·The Journal of Trauma and Acute Care Surgery·Alison R GardnerJohn Petty
Mar 11, 2015·The Journal of Trauma and Acute Care Surgery·Binod ShresthaCharles E Wade
Oct 12, 2016·Journal of the American College of Surgeons·Martin SillesenHasan B Alam
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Dec 26, 2013·The Journal of Trauma and Acute Care Surgery·Martin SillesenHasan B Alam
Apr 24, 2013·The Journal of Trauma and Acute Care Surgery·Martin SillesenHasan B Alam
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Jul 19, 2017·PLoS Medicine·Hasan B Alam
Apr 14, 2020·The Journal of Trauma and Acute Care Surgery·Amanda M ChipmanRosemary A Kozar
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Apr 14, 2020·The Journal of Trauma and Acute Care Surgery·Rachel RussoHasan B Alam
Jul 1, 2019·Neuroscience and Biobehavioral Reviews·Andrew R MayerSheila M Alonzo

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