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Christmas N, Vakil AU, Hatch CJ, Dong S, Fikhman D, Beaman HT, Monroe MBB. Characterization of shape memory polymer foam hemostats in in vitro hemorrhagic wound models. J Biomed Mater Res B Appl Biomater 2020; 109:681-692. [PMID: 32969163 DOI: 10.1002/jbm.b.34732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/19/2020] [Accepted: 09/15/2020] [Indexed: 11/05/2022]
Abstract
Shape memory polymer foam hemostats are a promising option for future hemorrhage control in battlefield wounds. To enable their use as hemostatic devices, they must be optimized in terms of formulation and architecture, and their safety and efficacy must be characterized in animal models. Relevant in vitro models can be used for device optimization to help mitigate the excess use of animals and reduce costs of clinical translation. In this work, a simplified gunshot wound model and a grade V liver injury model were constructed. The models were used to characterize the effects of shape memory polymer foam hemostat geometry on wall pressures, application/removal times, hemorrhage (fluid loss), and fluid absorption in comparison with clinical controls. It was found that there is no benefit in over-sizing the hemostatic device relative to wound volume and that geometry effects are dependent upon the wound type. These models provide a rapid means for elucidation of promising hemostat geometries and formulations for use in future in vivo testing.
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Affiliation(s)
- Nakira Christmas
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
| | - Anand Utpal Vakil
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
| | - Christopher J Hatch
- Department of Biomedical Engineering, California Polytechnic State University, San Luis Obispo, California, USA
| | - Shi Dong
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
| | - David Fikhman
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
| | - Henry T Beaman
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
| | - Mary Beth B Monroe
- Department of Biomedical and Chemical Engineering, Syracuse Biomaterials Institute, and BioInspired Syracuse, Syracuse University, Syracuse, New York, USA
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Eschbach D, Horst K, Sassen M, Andruszkow J, Mohr J, Debus F, Vogt N, Steinfeldt T, Hildebrand F, Schöller K, Uhl E, Wulf H, Ruchholtz S, Pape H, Frink M. Hypothermia does not influence liver damage and function in a porcine polytrauma model. Technol Health Care 2018; 26:209-221. [PMID: 28968251 DOI: 10.3233/thc-171043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies revealed evidence that induced hypothermia attenuates ischemic organ injuries after severe trauma. In the present study, the effect of hypothermia on liver damage was investigated in a porcine long term model of multi-system injury, consisting of blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shockMETHODS: In 30 pigs, a standardized polytrauma including blunt chest trauma, penetrating abdominal trauma, musculoskeletal injury, and hemorrhagic shock of 45% of total blood volume was induced. Following trauma, hypothermia of 33∘C was induced for 12 h and intensive care treatment was evaluated for 48 h. As outcome parameters, we assessed liver function and serum transaminase levels as well as a histopathological analysis of tissue samples. A further 10 animals served as controls. RESULTS Serum transaminase levels were increased at the end of the observation period following hypothermia without reaching statistical significance compared to normothermic groups. Liver function was preserved (p⩽ 0.05) after the rewarming period in hypothermic animals but showed no difference at the end of the observation period. In H&E staining, cell death was slightly increased hypothermic animals and caspase-3 staining displayed tendency towards more apoptosis in hypothermic group as well. CONCLUSIONS Induction of hypothermia could not significantly improve hepatic damage during the first 48 h following major trauma. Further studies focusing on multi-organ failure including a longer observation period are required to illuminate the impact of hypothermia on hepatic function in multiple trauma patients.
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Affiliation(s)
- D Eschbach
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - K Horst
- Trauma Department, University of Aachen, Aachen, Germany
| | - M Sassen
- Department of Anesthesiology and Critical Care, University Hospital Giessen and Marburg, Marburg, Germany
| | - J Andruszkow
- Institute of Pathology, University of Aachen, Aachen, Germany
| | - J Mohr
- Department of Trauma Surgery, University of Magdeburg, Magdeburg, Germany
| | - F Debus
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - N Vogt
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - T Steinfeldt
- Department of Anesthesiology and Critical Care, Diakonie-Klinikum Schwäbisch Hall, Germany
| | - F Hildebrand
- Trauma Department, University of Aachen, Aachen, Germany
| | - K Schöller
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - E Uhl
- Department of Neurosurgery, University Hospital Giessen and Marburg, Giessen, Germany
| | - H Wulf
- Department of Anesthesiology and Critical Care, University Hospital Giessen and Marburg, Marburg, Germany
| | - S Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - H Pape
- Department of Trauma, University of Zurich, Zurich, Switzerland
| | - M Frink
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
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Valparaiso AP, Vicente DA, Bograd BA, Elster EA, Davis TA. Modeling acute traumatic injury. J Surg Res 2014; 194:220-32. [PMID: 25481528 DOI: 10.1016/j.jss.2014.10.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 10/16/2014] [Accepted: 10/17/2014] [Indexed: 11/26/2022]
Abstract
Acute traumatic injury is a complex disease that has remained a leading cause of death, which affects all ages in our society. Direct mechanical insult to tissues may result in physiological and immunologic disturbances brought about by blood loss, coagulopathy, as well as ischemia and reperfusion insults. This inappropriate response leads to an abnormal release of endogenous mediators of inflammation that synergistically contribute to the incidence of morbidity and mortality. This aberrant activation and suppression of the immune system follows a bimodal pattern, wherein activation of the innate immune responses is followed by an anti-inflammatory response with suppression of the adaptive immunity, which can subsequently lead secondary insults and multiple organ dysfunction. Traumatic injury rodent and swine models have been used to describe many of the underlying pathologic mechanisms, which have led to an improved understanding of the morbidity and mortality associated with critically ill trauma patients. The enigmatic immunopathology of the human immunologic response after severe trauma, however, has never more been apparent and there grows a need for a clinically relevant animal model, which mimics this immune physiology to enhance the care of the most severely injured. This has necessitated preclinical studies in a more closely related model system, the nonhuman primate. In this review article, we summarize animal models of trauma that have provided insight into the clinical response and understanding of cellular mechanisms involved in the onset and progression of ischemia-reperfusion injury as well as describe future treatment options using immunomodulation-based strategies.
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Affiliation(s)
- Apple P Valparaiso
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Diego A Vicente
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Benjamin A Bograd
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric A Elster
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thomas A Davis
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland.
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Duggan MJ, Mejaddam AY, Beagle J, Demoya MA, Velmahosa GC, Alam HB, Rago A, Zugates G, Busold R, Freyman T, Sharma U, King DR. Development of a lethal, closed-abdomen grade V hepato-portal injury model in non-coagulopathic swine. J Surg Res 2012; 182:101-7. [PMID: 22921917 DOI: 10.1016/j.jss.2012.07.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 07/05/2012] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hemorrhage within an intact abdominal cavity remains a leading cause of preventable death on the battlefield. Despite this need, there is no existing closed-cavity animal model to assess new hemostatic agents for the preoperative control of intra-abdominal hemorrhage. METHODS We developed a novel, lethal liver injury model in non-coagulopathic swine by strategic placement of two wire loops in the medial liver lobes including the hepatic and portal veins. Distraction resulted in grade V liver laceration with hepato-portal injury, massive bleeding, and severe hypotension. Crystalloid resuscitation was started once mean arterial pressure (MAP) fell below 65 mm Hg. Monitoring continued for up to 180 min. RESULTS We demonstrated 90% lethality (9/10) in swine receiving injury and fluid resuscitation, with a mean survival time of 43 min. Previous efforts in our laboratory to develop a consistently lethal swine model of abdominal solid organs, including preemptive anticoagulation, a two-hit injury with controlled hemorrhage prior to liver trauma, and the injury described above without resuscitation, consistently failed to result in lethal injury. CONCLUSION This model can be used to screen other interventions for pre hospital control of noncompressible.
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Affiliation(s)
- Michael J Duggan
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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