Joseph Edwards1, Hossam Abdou1, Neerav Patel1, Eric Lang1, Michael J Richmond1, Todd E Rasmussen2, Thomas M Scalea1, Jonathan J Morrison3. 1. Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA. 2. Uniformed Services University of the Health Sciences, Bethesda, MD, USA. 3. Adams Cowley Shock Trauma Center, University of Maryland Medical System, 22 S. Greene Street, Baltimore, MD, 21201, USA. jonathan.morrison@som.umaryland.edu.
Abstract
AIM: To describe and compare the aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) generated during open chest selective aortic arch perfusion (OCSAAP) with those generated during open cardiac massage (OCM) in hypovolemic swine. METHODS: Ten male Hanford swine utilized in a prior poly-trauma study were included in the study. Animals were rendered hypovolemic via a 30% volume bleed. Upon confirmation of death, animals underwent immediate clamshell thoracotomy and aortic cross-clamping followed by 5 min of OCM. A catheter suitable for OCSAAP was then inserted into the aorta and animals underwent 1 min of OCSAAP at a rate of 10 mL/kg/min. Aortic and right atrial pressures were recorded continuously using solid-state blood pressure catheters. Representative 10-s intervals from each resuscitation method were extracted. Hemodynamic parameters including AoP-RAP gradients and CPPs were calculated and compared. RESULTS: At baseline, time from death to intervention was significantly shorter for OCM. However, mean CPPs and AoP-RAP gradients were significantly higher in animals undergoing OCSAAP. 98% of OCSAAP segments had a mean CPP > 15, compared to 35% of OCM intervals. While OCM had a significant negative correlation between time to intervention and maximum CPP, this correlation was not significant for OCSAAP. CONCLUSION: OCSAAP generates favorable and potentially time-resistant pressure gradients when compared to those generated by OCM. Further investigation of the technique of OCSAAP is warranted, as it may have potential utility as a therapy during resuscitative thoracotomy (RT).
AIM: To describe and compare the aortic-right atrial pressure (AoP-RAP) gradients and mean coronary perfusion pressures (CPPs) generated during open chest selective aortic arch perfusion (OCSAAP) with those generated during open cardiac massage (OCM) in hypovolemic swine. METHODS: Ten male Hanford swine utilized in a prior poly-trauma study were included in the study. Animals were rendered hypovolemic via a 30% volume bleed. Upon confirmation of death, animals underwent immediate clamshell thoracotomy and aortic cross-clamping followed by 5 min of OCM. A catheter suitable for OCSAAP was then inserted into the aorta and animals underwent 1 min of OCSAAP at a rate of 10 mL/kg/min. Aortic and right atrial pressures were recorded continuously using solid-state blood pressure catheters. Representative 10-s intervals from each resuscitation method were extracted. Hemodynamic parameters including AoP-RAP gradients and CPPs were calculated and compared. RESULTS: At baseline, time from death to intervention was significantly shorter for OCM. However, mean CPPs and AoP-RAP gradients were significantly higher in animals undergoing OCSAAP. 98% of OCSAAP segments had a mean CPP > 15, compared to 35% of OCM intervals. While OCM had a significant negative correlation between time to intervention and maximum CPP, this correlation was not significant for OCSAAP. CONCLUSION: OCSAAP generates favorable and potentially time-resistant pressure gradients when compared to those generated by OCM. Further investigation of the technique of OCSAAP is warranted, as it may have potential utility as a therapy during resuscitative thoracotomy (RT).
Authors: Joseph Edwards; Hossam Abdou; Marta J Madurska; Neerav Patel; Michael J Richmond; David Poliner; Joseph M White; Todd E Rasmussen; Thomas M Scalea; Jonathan J Morrison Journal: Resuscitation Date: 2021-04-14 Impact factor: 5.262
Authors: Matthew J Bradley; Brandon W Bonds; Luke Chang; Shiming Yang; Peter Hu; Hsiao-Chi Li; Megan L Brenner; Thomas M Scalea; Deborah M Stein Journal: J Trauma Acute Care Surg Date: 2016-11 Impact factor: 3.313
Authors: David R Jeffcoach; Juan J Gallegos; Sophy A Jesty; Patricia N Coan; Jason Chen; Robert Eric Heidel; Brian J Daley Journal: J Trauma Acute Care Surg Date: 2016-07 Impact factor: 3.313
Authors: Kenton L Anderson; Alejandra G Mora; Andrew D Bloom; Joseph K Maddry; Vikhyat S Bebarta Journal: Resuscitation Date: 2019-02-27 Impact factor: 5.262
Authors: Neerav Patel; Joseph Edwards; Hossam Abdou; David P Stonko; Rebecca N Treffalls; Noha N Elansary; Thomas Ptak; Jonathan J Morrison Journal: Front Physiol Date: 2022-10-04 Impact factor: 4.755