Long-term consequences of abdominal aortic and junctional tourniquet for hemorrhage control.

Autor: Kheirabadi BS; US Army Institute of Surgical Research, San Antonio, Texas. Electronic address: bijan.s.kheirabadi.civ@mail.mil., Terrazas IB; US Army Institute of Surgical Research, San Antonio, Texas., Miranda N; US Army Institute of Surgical Research, San Antonio, Texas., Voelker AN; US Army Institute of Surgical Research, San Antonio, Texas., Klemcke HG; US Army Institute of Surgical Research, San Antonio, Texas., Brown AW; US Army Institute of Surgical Research, San Antonio, Texas., Dubick MA; US Army Institute of Surgical Research, San Antonio, Texas.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2018 Nov; Vol. 231, pp. 99-108. Date of Electronic Publication: 2018 Jun 13.
DOI: 10.1016/j.jss.2018.05.017
Abstrakt: Background: Specialized tourniquets have been deployed to the battlefield for the control of junctional/pelvic hemorrhage despite limited knowledge concerning their safety and duration of use. This study investigated long-term effects of abdominal application of the abdominal aortic and junctional tourniquet (AAJT) in a swine survival model.
Methods: Anesthetized spontaneously air-breathing swine were subjected to bilateral femoral artery injuries and subsequent 40% hemorrhage. Further hemorrhage was controlled by applying the AAJT on the lower abdomen for 0 h (n = 2, controls), 1 h (n = 6), 1.5 h (n = 6), or 2 h (n = 3). Before tourniquet release, arterial injuries were repaired, and mechanical ventilation and rapid crystalloid fluid were provided for at least 5 min. Additional fluid and 500 mL autologous blood were transfused after restoring blood flow. Animals were recovered and their mobility and health monitored up to 2 wk.
Results: AAJT application occluded the infrarenal abdominal aorta and stopped bilateral groin hemorrhage with rapid reversal of hemorrhagic shock and improved cranial blood pressure. All animals including controls recovered overnight but regaining hind leg function varied among AAJT-treated groups. In contrast to 1 h AAJT-treated swine that recovered full mobility in 1 wk, 2 h animals developed persistent hind leg paraplegia concurrent with urinary retention and ischemic necrosis of lumber muscles and had to be euthanized 3 d after surgery. Half of the 1.5-h group also had to be euthanized early due to paraplegia, whereas the other half recovered motor function within 2 wk.
Conclusions: The results of this animal study indicated that ischemic reperfusion injuries associated with abdominal application of the AAJT were time-dependent. To avoid permanent injuries, AAJT application on the abdomen to control a groin hemorrhage could not be longer than 1 h. This was consistent with recent instructions for application of this tourniquet on the abdomen in patients.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: