Zhang Hua-Yu, Guo Yong, Zhao Dong-Chu, Huang Xiao-Ying, Li Yang, Zhang Lian-Yang
Department of Trauma Surgery, Medical Center of Trauma and War Injury, State Key Laboratory of Trauma, Burns and Combined Injuries, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
Emergency and Critical Care Center, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Heliyon. 2024 Aug 30;10(17):e37017. doi: 10.1016/j.heliyon.2024.e37017. eCollection 2024 Sep 15.
Non-compressible torso hemorrhage (NCTH) presents the ultimate challenge in pre-hospital care. While external hemorrhage control devices (EHCDs) such as the Abdominal Aortic and Junctional Tourniquet (AAJT) and SAM Junctional Tourniquet (SJT) have been invented, the current design and application strategy requires further improvement. Therefore, researchers devised a novel apparatus named Modified EHCD (M-EHCD) and implemented intermittent hemostasis (IH) as a preventive measure against ischemia-reperfusion injury. The objective of this study was to ascertain the combined effect of M-EHCD and IH on the hemostatic effect of NCTH.
Eighteen swine were randomized to M-EHCD, AAJT or SJT. The NCTH model was established by inducing Class Ⅲ hemorrhagic shock and performing a hemi-transection of common femoral artery (CFA). EHCDs were rapidly fastened since the onset of free bleeding (T). The IH strategy was implemented by fully releasing M-EHCD at T, T and T, respectively, whereas AAJT and SJT maintained continuous hemostasis (CH) until T. All groups underwent CFA bridging at T, and EHCDs were removed at T. Reperfusion lasted for 60 min, after which euthanasia was performed. Hemodynamics, intra-vesical pressure (IVP), and blood samples were collected periodically. Histological examinations were also conducted.
M-EHCD demonstrated the fastest application time (M-EHCD: 26.38 ± 6.32s vs. SJT: 30.84 ± 5.62s vs. AAJT: 54.28 ± 5.45s, < 0.001) and reduced free blood loss (M-EHCD: 17.77 ± 9.85g vs. SJT: 51.80 ± 33.70g vs. AAJT: 115.20 ± 61.36g, = 0.011) compared to SJT and AAJT. M-EHCD exhibited inhibitory effects on heart rate (M-EHCD: 91.83 ± 31.61bpm vs. AAJT: 129.00 ± 32.32bpm vs. SJT: 135.17 ± 21.24bpm, = 0.041) and shock index. The device's external pressure was lowest in M-EHCD and highest in SJT ( = 0.001). The resultant increase in IVP were still the lowest in M-EHCD (M-EHCD: -0.07 ± 0.45 mmHg vs. AAJT: 27.04 ± 5.03 mmHg vs. SJT: 5.58 ± 2.55 mmHg, < 0.001). Furthermore, M-EHCD caused the least colonic injury (M-EHCD: 1.17 ± 0.41 vs. AAJT: 2.17 ± 0.41 vs. SJT: 2.17 ± 0.41, = 0.001). The removal of M-EHCD showed the slightest impact on pH ( < 0.001), while AAJT group was more susceptible to the lethal triad based on the arterial lactate and thrombelastogram results.
M-EHCD + IH protected the organs and reduced the risk of the lethal triad by decreasing disruptions to IVP, hemodynamics, acid-base equilibrium and coagulation. M-EHCD + IH was superior to the hemostatic safety and efficacy of AAJT/SJT + CH.
不可压缩性躯干出血（NCTH）是院前急救中的终极挑战。虽然已经发明了诸如腹主动脉和关节止血带（AAJT）以及SAM关节止血带（SJT）等外部出血控制装置，但目前的设计和应用策略仍需进一步改进。因此，研究人员设计了一种名为改良外部出血控制装置（M-EHCD）的新型器械，并实施间歇性止血（IH）作为预防缺血再灌注损伤的措施。本研究的目的是确定M-EHCD和IH对NCTH止血效果的联合作用。
将18头猪随机分为M-EHCD组、AAJT组或SJT组。通过诱导Ⅲ级失血性休克并对股总动脉（CFA）进行半横断来建立NCTH模型。自自由出血开始（T）起迅速固定外部出血控制装置。IH策略是分别在T、T和T时完全松开M-EHCD，而AAJT和SJT保持持续止血（CH）直至T。所有组在T时进行CFA搭桥，并在T时移除外部出血控制装置。再灌注持续60分钟，之后实施安乐死。定期采集血流动力学、膀胱内压（IVP）和血样。还进行了组织学检查。
与SJT和AAJT相比，M-EHCD的应用时间最快（M-EHCD：26.38±6.32秒 vs. SJT：30.84±5.62秒 vs. AAJT：54.28±5.45秒，<0.001），且减少了自由失血量（M-EHCD：17.77±9.85克 vs. SJT：51.80±33.70克 vs. AAJT：115.20±61.36克，=0.011）。M-EHCD对心率（M-EHCD：91.
