Madurska Marta J, Abdou Hossam, Richmond Michael J, Elansary Noha N, Wong Peng F, Rasmussen Todd E, Scalea Thomas M, Morrison Jonathan J
R Adams Cowley Shock Trauma Center.
Department of Vascular Surgery, The James Cook University Hospital.
J Vis Exp. 2020 Aug 25(162). doi: 10.3791/61573.
Hemorrhage constitutes the majority of potentially preventable deaths from trauma. There is growing interest in endovascular resuscitation techniques such as selective aortic arch perfusion (SAAP) for patients in cardiac arrest. This involves active perfusion of the coronary circulation via a thoracic aortic balloon catheter and is approaching clinical application. However, the technique is complex and requires refinement in animal models before human use can be considered. This paper describes a large animal model of exsanguination cardiac arrest treated with a bespoke SAAP system. Swine were anesthetized, instrumented and a splenectomy was performed before a controlled, logarithmic exsanguination was initiated. Animals were heparinized and the shed blood collected in a reservoir. Once cardiac arrest was observed, the blood was pumped through an extra-corporeal circuit into an oxygenator and then delivered through a 10 Fr balloon catheter placed in the thoracic aorta. This resulted in the return of a spontaneous circulation (ROSC) as demonstrated by ECG and aortic root pressure waveform. This model and accompanying SAAP system allow for standardized and reproducible recovery from exsanguination cardiac arrest.
出血是创伤导致的大多数潜在可预防死亡的原因。对于心脏骤停患者，诸如选择性主动脉弓灌注（SAAP）等血管内复苏技术越来越受到关注。这涉及通过胸主动脉球囊导管对冠状动脉循环进行主动灌注，并且已接近临床应用。然而，该技术很复杂，在考虑用于人体之前需要在动物模型中进行改进。本文描述了一种使用定制SAAP系统治疗失血性心脏骤停的大型动物模型。猪被麻醉、插管，并在开始控制性对数放血之前进行脾切除术。动物接受肝素化处理，流出的血液收集在一个储液器中。一旦观察到心脏骤停，血液就通过体外循环泵入氧合器，然后通过放置在胸主动脉的10 Fr球囊导管输送。如心电图和主动脉根部压力波形所示，这导致了自主循环恢复（ROSC）。该模型及配套的SAAP系统允许从失血性心脏骤停中实现标准化和可重复的恢复。
