Optimal Surgical Therapy in a Porcine (Sus scrofa) Model of Extra-Thoracic Penetrating Trauma Resulting in Hemorrhagic Shock: ED Thoracotomy vs. Immediate Trans-Abdominal Vascular Control. A Porcine Model for Evaluating the Management of Non-Compressible Torso Hemorrhage

Abstract : This report introduces a standardized large animal model of non-compressible torso hemorrhage which permits assessment of different management strategies for this relatively common and extremely challenging combat injury pattern. Class IV hemorrhagic shock was induced in anesthetized adult swine through an iliac arterial injury and animals were randomized to different treatment groups. Following vascular control, the injury was shunted, and damage control resuscitation was performed. Serum markers, intravenous fluid volumes, and vasopressor requirements were tracked. Post-mortem tissue analysis was performed to compare levels of acute schemic injury between groups. After model development (n=6), treatment animals underwent non-compressible hemorrhage with thoracic aortic clamping (n=6), supra-celiac aortic clamping (n=6), direct vascular control (n=6), and endovascular aortic occlusion n=6). This study presents a large animal model of class IV hemorrhagic shock from non-compressible hemorrhage which permits comparison of various vascular control methods to address this challenging problem. Future studies utilizing this standardized model will allow further development of strategies for the management of non-compressible hemorrhage.