title: Abdominal insufflation for prevention of exsanguination.
abstract: BACKGROUND
  Currently, traumatic intra-abdominal hemorrhage continues unchecked during transport and triage, and a simple technique of prehospital hemostasis might improve outcomes. The hemostatic effect of abdominal hypertension has not been studied.
  
  
  OBJECTIVE
  To examine the effect of iatrogenic abdominal insufflation on blood loss and hemodynamic performance after major abdominal vascular injury.
  
  
  METHODS
  Following laparotomy, a 2.7 mm hole was created in the inferior vena cava of 10 anticoagulated pigs and controlled with a partially occlusive, laparoscopic vascular clamp. After abdominal closure the clamp was released and the pig was randomized to either control (n = 5) or immediate abdominal CO2 insufflation at 20 cm H2O pressure (n = 5). Lactated Ringer's solution was used as needed to maintain a mean arterial pressure of 60 mm Hg. After 15 minutes of hemorrhage and hemodynamic monitoring, the animals were killed and blood loss measured. Mean blood loss was compared between groups using the Student test, as were final values for physiologic variables. Temporal changes in physiologic parameters were compared using analysis of variance.
  
  
  RESULTS
  Mean blood loss was reduced by 61% in insufflated pigs versus controls (695 +/- 244 versus 1764 +/- 328 cc, p < 0.001). Compared with controls, insufflated pigs had significantly higher mean arterial pressure (64 versus 25 mm Hg, p < 0.001), end-tidal CO2 (40.8 versus 17.8 mm Hg, p < 0.001), and pulmonary capillary wedge pressure (10.2 versus 5.8 mm Hg, p = 0.026) immediately before the pigs were killed.
  
  
  CONCLUSIONS
  Iatrogenic abdominal insufflation significantly decreased blood loss and improved hemodynamics in a porcine model of traumatic venous hemorrhage. Iatrogenic abdominal insufflation may be useful in the prehospital management of abdominal injury.
authors.affiliation: Department of Surgery, Division of Trauma and Critical Care, University of Southern California Keck School of Medicine, USA. Jack.a.sava@medstar.net
authors.forename: Jack
authors.initials: J
authors.lastname: Sava
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.forename: Marios
authors.initials: M
authors.lastname: Karaiskakis
authors.forename: Paul
authors.initials: P
authors.lastname: Kirkman
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Toutouzas
authors.forename: Grant
authors.initials: G
authors.lastname: Sarkisyan
authors.forename: Linda
authors.initials: L
authors.lastname: Chan
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006439:Hemodynamics; D006487:Hemostasis; D007327:Insufflation / Q000379:methods*; D007813:Laparotomy; D013552:Swine