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

Publication ,  Journal Article
Jin, G; DeMoya, MA; Duggan, M; Knightly, T; Mejaddam, AY; Hwabejire, J; Lu, J; Smith, WM; Kasotakis, G; Velmahos, GC; Socrate, S; Alam, HB
Published in: Shock
July 2012

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, brains were sectioned into 5-mm slices and stained with TTC (2,3,5-triphenyltetrazolium chloride) to quantify the lesion size and brain swelling. Combination of 40% blood loss with cortical impact and a period of shock (2 h) resulted in a highly reproducible brain injury. Total fluid requirements were lower in the Hex and FFP groups. Lesion size and brain swelling in the FFP group (2,160 ± 202.63 mm and 22% ± 1.0%, respectively) were significantly smaller than those in the NS group (3,285 ± 130.8 mm3 and 37% ± 1.6%, respectively) (P < 0.05). Hex treatment decreased the swelling (29% ± 1.6%) without reducing the lesion size. Early administration of FFP reduces the size of brain lesion and associated swelling in a large animal model of TBI + HS. In contrast, artificial colloid (Hex) decreases swelling without reducing the actual size of the brain lesion.

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Published In

Shock

DOI

EISSN

1540-0514

Publication Date

July 2012

Volume

38

Issue

1

Start / End Page

49 / 56

Location

United States

Related Subject Headings

  • Sus scrofa
  • Sodium Chloride
  • Shock, Hemorrhagic
  • Resuscitation
  • Plasma
  • Partial Pressure
  • Oxygen
  • Intracranial Pressure
  • Hydroxyethyl Starch Derivatives
  • Hemodynamics
 

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Jin, G., DeMoya, M. A., Duggan, M., Knightly, T., Mejaddam, A. Y., Hwabejire, J., … Alam, H. B. (2012). Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock, 38(1), 49–56. https://doi.org/10.1097/SHK.0b013e3182574778
Jin, Guang, Marc A. DeMoya, Michael Duggan, Thomas Knightly, Ali Y. Mejaddam, John Hwabejire, Jennifer Lu, et al. “Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults.Shock 38, no. 1 (July 2012): 49–56. https://doi.org/10.1097/SHK.0b013e3182574778.
Jin G, DeMoya MA, Duggan M, Knightly T, Mejaddam AY, Hwabejire J, et al. Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock. 2012 Jul;38(1):49–56.
Jin, Guang, et al. “Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults.Shock, vol. 38, no. 1, July 2012, pp. 49–56. Pubmed, doi:10.1097/SHK.0b013e3182574778.
Jin G, DeMoya MA, Duggan M, Knightly T, Mejaddam AY, Hwabejire J, Lu J, Smith WM, Kasotakis G, Velmahos GC, Socrate S, Alam HB. Traumatic brain injury and hemorrhagic shock: evaluation of different resuscitation strategies in a large animal model of combined insults. Shock. 2012 Jul;38(1):49–56.

Published In

Shock

DOI

EISSN

1540-0514

Publication Date

July 2012

Volume

38

Issue

1

Start / End Page

49 / 56

Location

United States

Related Subject Headings

  • Sus scrofa
  • Sodium Chloride
  • Shock, Hemorrhagic
  • Resuscitation
  • Plasma
  • Partial Pressure
  • Oxygen
  • Intracranial Pressure
  • Hydroxyethyl Starch Derivatives
  • Hemodynamics