title: A laparoscopic swine model of noncompressible torso hemorrhage.
abstract: BACKGROUND
  Hemorrhage persists as the leading cause of potentially preventable civilian and military death. Noncompressible torso hemorrhage (NCTH) is a particularly lethal injury complex, with few contemporary prehospital interventions available. Various porcine models of hemorrhage have been developed for civilian and military trauma research. However, the predominant contemporary models lack key physiologic characteristics including the natural tamponade provided by an intact abdominal wall.To improve physiologic and clinical relevance, we developed a laparoscopic model of NCTH. This approach maintains both the integrity of the peritoneum and the natural tamponade effect of an intact abdominal wall while preserving the intrinsic physiologic responses to hemorrhage. Furthermore, we present data quantifying the contribution of the swine contractile spleen in the context of uncontrolled hemorrhage.
  
  
  METHODS
  Anesthetized adult male Yorkshire swine underwent a laparoscopic Grade V liver injury, with or without open preinjury splenectomy. Animals were observed without intervention for a total of 120 minutes after injury to simulate point of injury, transport time, and arrival at hospital.
  
  
  RESULTS
  Shed blood-to-body weight ratio did not differ among groups; however, mortality was higher in splenectomized animals (67% vs. 33%). Cox regression modeling demonstrated a critical time point of 45 minutes and blood pressure as significant predictors of mortality.
  
  
  CONCLUSIONS
  This study describes a model of NCTH that reflects clinically relevant physiology in trauma and uncontrolled hemorrhage. In addition, it quantitatively assesses the role of the swine contractile spleen in the described model.
authors.affiliation: From the 59th Medical Wing (J.D.R., E.M.S., L.-A.Z.), Science and Technology Office, Trauma and Clinical Care Research Directorate, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, San Antonio, Texas; Walter Reed National Military Medical Center at Bethesda (C.J.B.), Bethesda, Maryland; and Academic Department Military Surgery and Trauma (J.J.M.), Royal Centre for Defence Medicine, Birmingham; and Academic Unit of Surgery (J.J.M.), Glasgow Royal Infirmary, Glasgow, United Kingdom.
authors.forename: James D
authors.initials: JD
authors.lastname: Ross
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Burns
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Sagini
authors.forename: Lee-Ann
authors.initials: LA
authors.lastname: Zarzabal
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
mesh_terms: D000007:Abdominal Injuries / Q000473:pathology / Q000503:physiopathology; D000818:Animals; D004195:Disease Models, Animal; D006470:Hemorrhage / Q000473:pathology / Q000503:physiopathology; D010535:Laparoscopy; D008099:Liver / Q000293:injuries; D008297:Male; D013154:Spleen / Q000293:injuries; D013552:Swine; D013997:Time Factors