Abdominal insufflation for control of bleeding after severe splenic injury.
BACKGROUND
To date, there is no rapid method to control intracavitary bleeding without an operation. Over 70% of trauma deaths from uncontrollable internal bleeding occur early after injury before an operation is feasible. Abdominal insufflation (AI) by carbon dioxide has been shown to reduce the rate of bleeding after intra-abdominal injury in pigs. The concept was proven in highly lethal models of severe vascular and liver injuries. Similar injuries in humans would result in immediate exsanguination and low likelihood for any intervention. We hypothesized that AI would similarly reduce bleeding in a model of moderate but persistent bleeding from a splenic injury. This model represents a clinically relevant scenario of continuous bleeding, which does not kill the patient immediately but may ultimately result in death if not managed early.


METHODS
A new model of splenic injury was applied on 19 pigs, randomized to standard resuscitation (SR, N = 10) or standard resuscitation with AI to 20 cm H2O (SRAI, N = 9). For 30 minutes, the pigs were bled and the hemodynamics recorded. At 30 minutes, the abdomen was opened and free blood was collected and measured. Outcomes were blood loss, mean arterial pressure, hemoglobin, lactate levels, and arterial blood gases at the end of the experiment.


RESULTS
All pigs survived to the end of the experiment. Blood loss was lower (1,114 +/- 486 mL vs. 666 +/- 323 mL, p = 0.03) and final mean arterial pressure higher (64 +/- 12 mm Hg vs. 54 +/- 8 mm Hg, p = 0.04) in SRAI when compared with those in SR animals. Heart rate, arterial blood gases, oxygen saturation, hemoglobin, and lactate levels were similar in the two groups, except there was a more acidotic pH among SRAI animals (7.27 +/- 0.06 vs. 7.47 +/- 0.21, p = 0.02).


CONCLUSIONS
AI is a novel method to control intra-abdominal bleeding temporarily. With proper portable instruments and first-responder training, this is a technique that can potentially be used in the field to save lives from intra-abdominal exsanguination.
Velmahos
George C
GC
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, The Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA. gvelmahos@partners.org
Spaniolas
Konstantinos
K
Duggan
Michael
M
Alam
Hasan B
HB
Tabbara
Malek
M
de Moya
Marc
M
Vosburgh
Kirby
K
D000818:Animals; D001774:Blood Chemical Analysis; D002245:Carbon Dioxide / Q000494:pharmacology; D004195:Disease Models, Animal; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality* / Q000628:therapy*; D006489:Hemostatic Techniques; D015601:Injury Severity Score; D007327:Insufflation / Q000379:methods*; D008297:Male; D011336:Probability; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D012680:Sensitivity and Specificity; D013154:Spleen / Q000293:injuries*; D015996:Survival Rate; D013552:Swine
D002245:Carbon Dioxide