| 11. |
- Dogan, Emanuel M., 1984-, et al.
(författare)
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Resuscitative Endovascular Balloon Occlusion of the Aorta in Experimental Cardiopulmonary Resuscitation : Aortic Occlusion Level Matters
- 2019
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Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 52:1, s. 67-74
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Aortic occlusion during cardiopulmonary resuscitation (CPR) increases systemic arterial pressures. Correct thoracic placement during the resuscitative endovascular balloon occlusion of the aorta (REBOA) may be important for achieving effective CPR.HYPOTHESIS: The positioning of the REBOA in the thoracic aorta during CPR will affect systemic arterial pressures.METHODS: Cardiac arrest was induced in 27 anesthetized pigs. After 7 min of CPR with a mechanical compression device, REBOA in the thoracic descending aorta at heart level (zone Ib, REBOA-Ib, n = 9), at diaphragmatic level (zone Ic, REBOA-Ic, n = 9) or no occlusion (control, n = 9) was initiated. The primary outcome was systemic arterial pressures during CPR.RESULTS: During CPR, REBOA-Ic increased systolic blood pressure from 86 mmHg (confidence interval [CI] 71-101) to 128 mmHg (CI 107-150, P < 0.001). Simultaneously, mean and diastolic blood pressures increased significantly in REBOA-Ic (P < 0.001 and P = 0.006, respectively), and were higher than in REBOA-Ib (P = 0.04 and P = 0.02, respectively) and control (P = 0.005 and P = 0.003, respectively). REBOA-Ib did not significantly affect systemic blood pressures. Arterial pH decreased more in control than in REBOA-Ib and REBOA-Ic after occlusion (P = 0.004 and P = 0.005, respectively). Arterial lactate concentrations were lower in REBOA-Ic compared with control and REBOA-Ib (P = 0.04 and P < 0.001, respectively).CONCLUSIONS: Thoracic aortic occlusion in zone Ic during CPR may be more effective in increasing systemic arterial pressures than occlusion in zone Ib. REBOA during CPR was found to be associated with a more favorable acid-base status of circulating blood. If REBOA is used as an adjunct in CPR, it may be of importance to carefully determine the aortic occlusion level.The study was performed following approval of the Regional Animal Ethics Committee in Linköping, Sweden (application ID 418).
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| 12. |
- Duchesne, Juan, et al.
(författare)
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Delta Systolic Blood Pressure (SBP) Can be a Stronger Predictor of Mortality Than Pre-Aortic Occlusion SBP in Non-Compressible Torso Hemorrhage : an Abotrauma and AORTA Analysis
- 2021
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Ingår i: Shock. - : Biomedical Press. - 1073-2322 .- 1540-0514. ; 56:1S, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is becoming a standardized adjunct for the management in patients with severe non-compressible torso hemorrhage (NCTH). Although guidelines have been developed to help with the best indications for REBOA utilization, no studies have addressed the significance of change in systolic blood pressure (ΔSBP) after REBOA insufflation. We hypothesized that ΔSBP would predict mortality in patients with NCTH and have utility as a surrogate marker for hemorrhage status.STUDY DESIGN: This was an international, multicenter retrospective review of all patients managed with REBOA from the ABOTrauma Registry and the AORTA database. ΔSBP was defined as the difference between pre- and post-REBOA insertion SBP. Based on post-insertion SBP, patient hemorrhage status was categorized as responder or non-responder. A non-responder was defined as a hypotensive patient with systolic blood pressure (SBP) < 90 mmHg after REBOA placement with full aortic occlusion. Significance was set at P < 0.05.RESULTS: A total of 524 patients with NCTH were included. Most (74%) were male, 77% blunt injured with a median (IQR) age of 40 (27 - 58) years and ISS 34 (25 - 45). Overall mortality was 51.0%. 20% of patients were classified as non-responders. Demographic and injury descriptors did not differ between groups. Mortality was significantly higher in non-responders vs responders (64% vs 46%, respectively; P = 0.001). Non-responders had lower median pre-insertion SBP (50mmHg vs 67mmHg; P < 0.001) and lower ΔSBP (20mmHg vs 48mmHg; P < 0.001).CONCLUSION: REBOA non-responders present and remain persistently hypotensive and are more likely to die than responders, indicating a potential direct correlation between ΔSBP as a surrogate marker of hemorrhage volume status and mortality. Future prospective studies will need to further elucidate the impact of Damage Control Resuscitation efforts on ΔSBP and mortality.
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| 13. |
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| 14. |
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| 15. |
- Duchesne, Juan, et al.
(författare)
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Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged : A Summary of Current Civilian EMS Practices and New Military Changes
- 2021
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Ingår i: Shock. - : Lippincott Williams & Wilkins. - 1073-2322 .- 1540-0514. ; 56:1S, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- Mortality secondary to trauma related hemorrhagic shock has not improved for several decades. Underlying the stall in progress is the conundrum of effective pre-hospital interventions for hemorrhage control. As we know, neither pressing hard on the gas nor "Stay and play" have changed mortality over the last 20 years. For this reason, when dealing with effective changes that will improve severe hemorrhage mortality outcomes, there is a need for the creation of a hybrid pre-hospital model.Improvements in mortality outcomes for patients with severe hemorrhage based on evidence for common civilian prehospital procedures such as in-field intubation and immediate fluid resuscitation with crystalloid solution is weak at best. The use of tourniquets, once considered too risky to use, however, has risen dramatically in large part due success seen during their use in the military. Their use in the civilian setting shows promising results. Recently updated military Advanced Resuscitative Care (ARC) guidelines propose the use of prehospital whole blood transfusion as well as in-field use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA). Several case studies from Europe suggest these strategies are feasible for use in the civilian population, but could they be implemented in the U.S.?
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| 16. |
- Fröjse, R, et al.
(författare)
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Local metabolic effects of dopexamine on the intestine during mesenteric hypoperfusion.
- 2004
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Ingår i: Shock. - : Ovid Technologies (Wolters Kluwer Health). - 1073-2322 .- 1540-0514. ; 21:3, s. 241-7
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Tidskriftsartikel (refereegranskat)abstract
- This self-controlled experimental study was designed to test the hypothesis that dopexamine, a synthetic catecholamine that activates dopaminergic (DA-1) and beta2-adrenergic receptors, improves oxygenation in the jejunal mucosa during intestinal hypotension. In six normoventilated barbiturate-anesthetized pigs, controlled reductions in superior mesenteric arterial pressure (PSMA) was obtained by an adjustable clamp around the artery. Dopexamine infusions (0.5 and 1.0 microg.kg(-1).min(-1)) were administered at a freely variable PSMA (i.e., with the perivascular clamp fully open) and at a PSMA of 50 mmHg and 30 mmHg. We continuously measured superior mesenteric venous blood flow (QMES; transit-time ultrasonic flowmetry), jejunal mucosal perfusion (laser Doppler flowmetry), and tissue oxygen tension (PO2TISSUE; microoximetry). Jejunal luminal microdialysate of lactate, pyruvate, and glucose were measured every 5 min. Measurements of mucosal PCO2 (air tonometry), together with blood sampling and end-tidal PCO2 measurements, enabled calculations of pHi and PCO2 gap. Dopexamine reduced mesenteric vascular resistance and increased QMES at a PSMA of 50 mmHg and 30 mmHg. At a PSMA of 30 mmHg, dopexamine increased mesenteric oxygen delivery but did not influence mesenteric oxygen uptake or extraction. In this situation, dopexamine had no beneficial effect on jejunal mucosal blood flow. On the contrary, dopexamine increased mesenteric net lactate production and PCO2 gap, whereas PO2TISSUE and pHi decreased. Jejunal luminal microdialysate data demonstrated an increased lactate concentration and a pattern of decreased glucose concentration and increased luminal lactate-pyruvate ratio. These negative metabolic effects of dopexamine should be taken into account in situations of low perfusion pressures.
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| 17. |
- Gunnarsson, Ulf, 1967-, et al.
(författare)
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Centrally mediated influences of hypertonic NaCl and angiotensin II on regional blood flow and hemodynamic responses to hypotensive hemorrhage in conscious sheep.
- 1994
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Ingår i: Shock. - 1073-2322 .- 1540-0514. ; 2:1, s. 60-7
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Tidskriftsartikel (refereegranskat)abstract
- The influence of separate and combined intracerebroventricular (ICV) infusions of hypertonic (.5 M) NaCl (HTNa) at .02 mL min-1 and angiotensin II (ANG II) at 1 pmol kg-1 min-1 on tolerance to hemorrhage, accompanying systemic hemodynamic changes, and regional blood flow was studied in adult conscious sheep. Corresponding measurements during ICV .9% NaCl served as controls. The hemorrhage volume needed to lower the blood pressure to about 50 mmHg was significantly larger during treatment with HTNa and HTNa/ANG II (27.8 +/- 2.2 and 28.3 +/- 2.5 mL kg-1, respectively; p < .001; about 45% of estimated blood volume) as well as during ANG II (20.1 +/- 1.3 mL kg-1; p < .01) compared to controls (15.1 +/- .7 mL kg-1; about 25% of estimated blood volume). In spite of a larger hemorrhage volume, the lowering of the cardiac output was not accentuated, and its subsequent recovery was not impaired during ICV infusion of HTNa or HTNa/ANG II. Similarly, the posthemorrhage restoration of the systemic blood pressure was not negatively affected by the more pronounced hypovolemia induced during the ICV treatments compared to controls. In contrast to ANG II, HTNa infusion, alone or in combination with ANG II, was accompanied by a significantly lower renal blood flow, and a higher renovascular resistance, during the posthemorrhage period. The femoral blood flow was maintained or even slightly elevated after hemorrhage in all experiments. The integrated results of the study imply differentiated hemodynamic effects of centrally administered HTNa and ANG II.(ABSTRACT TRUNCATED AT 250 WORDS)
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| 18. |
- Hahn, Robert G., et al.
(författare)
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Kinetics of Ringers Solution in Extracellular Dehydration and Hemorrhage
- 2020
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Ingår i: Shock. - : LIPPINCOTT WILLIAMS & WILKINS. - 1073-2322 .- 1540-0514. ; 53:5, s. 566-573
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ringers solution might be used to treat volume depletion (extracellular dehydration) and hemorrhage, but there is no integrated view of how these fluid balance disorders influence the kinetics of the infused volume. Methods: Acute dehydration (mean 1.7 L) was induced by repeated doses of furosemide (5 mg) in 10 healthy male volunteers, and 0.5 L and 0.9 L of blood was withdrawn in random order on different occasions in another 10 male volunteers, just before administration of Ringers acetate solution. Infusions performed in the normovolemic state served as controls. Measurements of blood hemoglobin and urinary excretion were used to create volume kinetic profiles that were analyzed using mixed-effects modeling software. Results: Infusions over 15 to 30 min showed a marked distribution phase during which the plasma volume transiently increased by 50% to 75% of the administered volume. Dehydration and hemorrhage accelerated redistribution but retarded the elimination; the half-life of the infused fluid increased from 36 to 51 min (mean) from 1 L of dehydration and to 95 min from 1 L of hemorrhage. Extravascular accumulation decreased with the dehydration volume and increased with the hemorrhage volume. Simulations show that 60% as much Ringer is needed to replace volume depletion amounting to 1 L as compared with hemorrhage over a 2-h period. A continued but slower drip after the initial fluid resuscitation prevents rebound hypovolemia. Conclusions: Furosemide-induced dehydration and blood withdrawal in normotensive volunteers had modest effects on the Ringers acetate kinetics. Urinary excretion was inhibited more by hemorrhage than by dehydration.
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| 19. |
- Heinius, Goran, et al.
(författare)
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HYPOTHERMIA INCREASES REBLEEDING DURING UNCONTROLLED HEMORRHAGE IN THE RAT
- 2011
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Ingår i: Shock. - : Biomedical Press. - 1073-2322 .- 1540-0514. ; 36:1, s. 60-66
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Tidskriftsartikel (refereegranskat)abstract
- Trauma registers show that hypothermia (HT) is an independent risk factor for death during hemorrhagic shock, although experimental animal studies indicate that HT may be beneficial during these conditions. However, the animal models were not designed to detect the expected increase in bleeding caused by HT. In a new model for uncontrolled bleeding, 40 Sprague-Dawley rats were exposed to a standardized femoral artery injury and randomized to either normothermia or HT. Ketamine/midazolam was used to minimize hemodynamic changes due to the anesthesia. The hypothermic rats were cooled to 30 degrees C and rewarmed again at 90 min. The study period was 3 h. The incidence, onset time, duration, and volume of bleedings as well as hemodynamic and metabolic changes were recorded. There was no difference between groups with respect to the initial bleeding. Rebleedings occurred among 60% of the animals in both groups. Hypothermic rebleeders had more, larger, and longer rebleedings, resulting in a total rebleeding volume amounting to 41% of their estimated blood volume. The corresponding figure for the normothermic rebleeders was 3% (P less than 0.001). Total rebleeding volume was significantly larger in the hypothermic group, even at body temperatures greater than 35 degrees C. We conclude that the risk of rebleeding from a femoral injury is greater in the presence of cooling and HT. The larger rebleeding volumes seen even at body temperatures greater than 35 degrees C indicate that factors other than temperature-induced coagulopathy also contributed to the increased hemorrhage.
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| 20. |
- Hjelmqvist, H, et al.
(författare)
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Comparison between the effects of central and systemic hypertonic NaCl on hemodynamic responses to hemorrhage in sheep.
- 1995
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Ingår i: Shock. - 1073-2322 .- 1540-0514. ; 3:5, s. 355-61
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Tidskriftsartikel (refereegranskat)abstract
- Effects of treatment with systemic hypertonic (1.2M, 4 mL kg-1) NaCl (SHTNa) on tolerance to hemorrhage, accompanying systemic hemodynamics, and regional blood flow were investigated in conscious sheep. The results were compared with those obtained in animals subjected to hemorrhage during intracerebroventricular (ICV) administration of hypertonic (.5 M, .02 mL min -1) NaCl (CHTNa). Corresponding bleeding during ICV infusion of isotonic saline served as control. All treatments were started 30 min before commencement of a slow (.7 mL kg-1 min-1) hemorrhage, which was continued until the mean systemic arterial pressure (MSAP) suddenly dropped to about 50 mmHg. To reach the distinct fall in MSAP significantly more blood had to be withdrawn in the CHTNa (27.8 +/- 2.2 mL kg-1, p < .05) than in the SHTNa group (21.5 +/- 1.7 mL kg-1), which in turn showed a significantly higher tolerance to hemorrhage than the controls (15.1 +/- .7 mL kg-1, p < .01). The hemorrhage-induced reduction of cardiac output (CO) below basal level was less pronounced in the CHTNa group, where also the posthemorrhage CO recovery was most rapid. Spontaneous recovery of MSAP after bleeding was equally improved in both treatment groups with the central venous pressure being significantly higher in the SHTNa group. The hemorrhage-induced fall in renal blood flow (RBF) was more pronounced in the CHTNa group, which also had an impaired posthemorrhage recovery of RBF. In comparison to the SHTNa and control groups the renovascular resistance was significantly higher in the CHTNa group already during the prehemorrhage infusion period.(ABSTRACT TRUNCATED AT 250 WORDS)
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