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Abdominal Insufflation for Control of Bleeding after Severe Splenic Injury

Institution:
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. gvelmahos@partners.org
Publisher:
J Trauma
Publication Date:
Aug-2007
Volume Number:
63
Issue Number:
2
Pages:
288-290
Citation:
J Trauma. 2007 Aug;63(2):285-8; discussion 288-90.
PubMed ID:
17693825
Keywords:
exsanguinations, bleeding
Appears in Collections:
CIGL
Sponsors:
CIMIT under US Army MRMC Cooperative Agreement DAMD 17-02-2-0006
Generated Citation:
Velmahos G.C., Spaniolas K., Duggan M., Alam H.B., Tabbara M., de Moya M., Vosburgh K.G. Abdominal Insufflation for Control of Bleeding after Severe Splenic Injury. J Trauma. 2007 Aug;63(2):285-8; discussion 288-90. PMID: 17693825.
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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.