title: Development of a lethal, closed-abdomen, arterial hemorrhage model in noncoagulopathic swine.
abstract: BACKGROUND
  Prehospital treatment for noncompressible abdominal bleeding, particularly due to large vascular injury, represents a significant unmet medical need on the battlefield and in civilian trauma. To date, few large animal models are available to assess new therapeutic interventions and hemostatic agents for prehospital hemorrhage control.
  
  
  METHODS
  We developed a novel, lethal, closed-abdomen injury model in noncoagulopathic swine by strategic placement of a cutting wire around the external iliac artery. The wire was externalized, such that percutaneous distraction would result in vessel transection leading to severe uncontrolled abdominal hemorrhage. Resuscitation boluses were administered at 5 and 12 min.
  
  
  RESULTS
  We demonstrated 86% mortality (12/14 animals) at 60 min, with a median survival time of 32 min. The injury resulted in rapid and massive hypotension and exsanguinating blood loss. The noncoagulopathic animal model incorporated clinically significant resuscitation and ventilation protocols based on best evidenced-based prehospital practices.
  
  
  CONCLUSIONS
  A new injury model is presented that enables screening of prehospital interventions designed to control noncompressible arterial hemorrhage.
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Duggan
authors.affiliation: Arsenal Medical, Inc., Watertown, Massachusetts.
authors.forename: Adam
authors.initials: A
authors.lastname: Rago
authors.affiliation: Arsenal Medical, Inc., Watertown, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Marini
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Beagle
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Peev
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Velmahos
authors.affiliation: Arsenal Medical, Inc., Watertown, Massachusetts.
authors.forename: Upma
authors.initials: U
authors.lastname: Sharma
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: dking3@partners.org.
authors.forename: David R
authors.initials: DR
authors.lastname: King
mesh_terms: D000005:Abdomen; D000007:Abdominal Injuries / Q000401:mortality / Q000628:therapy*; D000818:Animals; D001458:Bandages; D004195:Disease Models, Animal; D004632:Emergency Medical Services / Q000379:methods; D058734:Exsanguination / Q000401:mortality / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use*; D007083:Iliac Artery / Q000293:injuries*; D008887:Military Medicine / Q000379:methods; D012151:Resuscitation / Q000379:methods / Q000401:mortality; D034421:Sus scrofa
chemical_list: D006490:Hemostatics
keywords: Artery; Battlefield; Bleeding; Exsanguination; Hemorrhage; Iliac; Resuscitation; Trauma