Development of a lethal, closed-abdomen, arterial hemorrhage model in noncoagulopathic swine

Abstract

Background: Prehospital treatment for noncompressible abdominal bleeding, particularly due to large vascular injury, represents a significant unmet medical need on the battlefield and in civilian trauma. To date, few large animal models are available to assess new therapeutic interventions and hemostatic agents for prehospital hemorrhage control.

Methods: We developed a novel, lethal, closed-abdomen injury model in noncoagulopathic swine by strategic placement of a cutting wire around the external iliac artery. The wire was externalized, such that percutaneous distraction would result in vessel transection leading to severe uncontrolled abdominal hemorrhage. Resuscitation boluses were administered at 5 and 12 min.

Results: We demonstrated 86% mortality (12/14 animals) at 60 min, with a median survival time of 32 min. The injury resulted in rapid and massive hypotension and exsanguinating blood loss. The noncoagulopathic animal model incorporated clinically significant resuscitation and ventilation protocols based on best evidenced-based prehospital practices.

Conclusion: A new injury model is presented that enables screening of prehospital interventions designed to control noncompressible arterial hemorrhage.

Keywords: Artery; Battlefield; Bleeding; Exsanguination; Hemorrhage; Iliac; Resuscitation; Trauma.