Jin Guang, Liggett Marjorie R, Ho Jessie W, Dawood Zaiba Shafik, Chtraklin Kiril, Diaz Dariel, Alam Hasan B
From the Department of Surgery, Northwestern Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Trauma Acute Care Surg. 2024 Dec 1;97(6):954-960. doi: 10.1097/TA.0000000000004457. Epub 2024 Oct 15.
Hemorrhage and traumatic brain injury (TBI) are the leading causes of death in trauma. Future military conflicts are likely to be in austere environments, where prolonged damage-control resuscitation (p-DCR) may be required for 72 hours before evacuation. Previous studies showed that early administration of fresh frozen plasma (FFP) during p-DCR can significantly decrease the volume of resuscitation required in models of hemorrhagic shock and also provide neuroprotection after TBI. In the current study, we hypothesized that the addition of FFP to p-DCR would decrease the resuscitation requirements and improve neurological outcomes in a large animal model of combined hemorrhagic shock and TBI.
Yorkshire swine (40-45 kg; n = 10) were subjected to TBI (controlled cortical impact) and 40% blood volume hemorrhage. After 2 hours of shock, they were randomized to either: (1) p-DCR-normal saline or (2) p-DCR-FFP (250 mL). Prolonged damage-control resuscitation targeted a systolic blood pressure of 90% of baseline, in line with Tactical Combat Casualty Care principles. At 72 hours, animals were transfused 1 U of packed red blood cells, simulating evacuation to higher echelons of care. Brain lesion size, physiologic parameters, resuscitation fluid requirements, and neurological severity score were used to compare the clinical outcomes.
The p-DCR-FFP group required significantly less total volume (4,540.0 ± 151.7 mL vs. 974.0 ± 167.0 mL, p < 0.01) of resuscitation to maintain the target systolic blood pressure. Fresh frozen plasma-treated animals had significantly reduced brain lesion size (4,517.0 ± 180.0 mm 3 vs. 2,477.0 ± 1,191.0 mm 3 , p < 0.01) and showed significantly decreased functional neurologic impairment.
In this exploratory study, treatment with FFP decreased resuscitation requirements, reduced brain lesion size, and improved neurological outcomes when added to prolonged DCR in a porcine model of combined hemorrhagic shock and TBI.
出血和创伤性脑损伤（TBI）是创伤死亡的主要原因。未来的军事冲突可能发生在资源匮乏的环境中，在撤离前可能需要进行72小时的延长损伤控制复苏（p-DCR）。先前的研究表明，在p-DCR期间早期输注新鲜冰冻血浆（FFP）可显著减少失血性休克模型中的复苏液体量，并在TBI后提供神经保护作用。在本研究中，我们假设在p-DCR中添加FFP会减少复苏需求，并改善出血性休克合并TBI的大型动物模型的神经学预后。
选用体重40 - 45千克的约克夏猪（n = 10），对其进行TBI（控制性皮质撞击）和40%血容量出血。休克2小时后，将它们随机分为两组：（1）p-DCR-生理盐水组或（2）p-DCR-FFP组（250毫升）。延长损伤控制复苏的目标是收缩压达到基线的90%，这符合战术战斗伤救治原则。在72小时时，给动物输注1单位浓缩红细胞，模拟后送至更高层级医疗机构进行治疗。通过脑损伤大小、生理参数、复苏液体需求量和神经严重程度评分来比较临床结果。
p-DCR-FFP组维持目标收缩压所需的复苏液体总量显著更少（4,540.0 ± 151.7毫升对974.0 ± 167.0毫升，p < 0.01）。接受FFP治疗的动物脑损伤大小显著减小（4,517.0 ± 180.0立方毫米对2,477.0 ± 1,191.0立方毫米，p < 0.01），并且功能神经损伤显著减轻。
在这项探索性研究中，在出血性休克合并TBI的猪模型中，在延长的DCR中添加FFP进行治疗可减少复苏需求，减小脑损伤大小，并改善神经学预后。
