Advertisement

Pediatric Surgery International

, Volume 34, Issue 7, pp 789–796 | Cite as

Clinical and laboratory predictors of blood loss in young swine: a model for pediatric hemorrhage

  • Xiaoming Shi
  • Mary J. Edwards
  • Jordan Guice
  • Richard Strilka
  • Brandon Propper
Original Article

Abstract

Background

The pediatric patient’s response to hemorrhage as a function of young age is not well understood. As a result, there is no consensus on optimal resuscitation strategies for hemorrhagic shock in pediatric patients, or on the identification of clinical triggers to prompt implementation. The study objective was to develop a model of pediatric hemorrhage using young pigs to simulate school-aged children, and determine clinical and laboratory indicators for significant hemorrhage.

Materials and methods

29 non-splenectomized female pigs, aged 3 months, weighing 30–40 kg, were randomized into groups with varying degrees of hemorrhage. Bleeding occurred intermittently over 5 h while the animals were anesthetized but spontaneously breathing. Various physiologic and biochemical markers were used to monitor the piglets during hemorrhage.

Results

Swine experiencing up to 50% hemorrhage survived without exception throughout the course of hemorrhage. 80% (4/5) of the animals in the 60% hemorrhage group survived. Need for respiratory support was universal when blood loss reached 50% of estimated blood volume. Blood pressure was not useful in classifying the degree of shock. Heart rate was helpful in differentiating between the extremes of blood loss examined. Arterial pCO2, pH, lactate, HCO3 and creatinine levels, as well as urine output, changed significantly with increasing blood loss.

Conclusions

Young swine are resilient against hemorrhage, although hemorrhage of 50% or greater universally require respiratory support. In this animal model, with the exception of heart rate, vital signs were minimally helpful in identification of shock. However, change in select laboratory values from baseline was significant with increasing blood loss.

Level of evidence

This was a level II prospective comparative study.

Keywords

Pediatric Hemorrhage Physiology Resuscitation Swine Transfusion 

Notes

Acknowledgements

The following people are gratefully acknowledged: Jennifer Cox for laboratory coordination; and James Aden, statistician.

Funding

This work was supported by the United States Air Force through a graduate medical education Grant from the 59th Medical Wing, Joint Base San Antonio/Lackland, TX, USA.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report.

Human and animal rights statement

All applicable international, national, and institutional guidelines for the care and use of animals were followed.

References

  1. 1.
    Holcomb JH, Del Junco DJ, Fox EE et al (2013) The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg 148(2):127–136CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Holcomb JH, Tilley BC, Baraniuk S et al (2015) Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 313(5):471–482CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Borgman MA, Spinella PC, Perkins JG et al (2007) The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma 63:805–813CrossRefPubMedGoogle Scholar
  4. 4.
    Cotton BA, Dossett LA, Haut ER et al (2010) Multicenter validation of a simplified score to predict massive transfusion in trauma. J Trauma 69(S1):S33–S39CrossRefPubMedGoogle Scholar
  5. 5.
    Seghatchian J, Samama MM (2012) Massive transfusion: an overview of the main characteristics and potential risks associated with substances used for correction of a coagulopathy. Transfus Apheresis Sci 47(2):235–243CrossRefGoogle Scholar
  6. 6.
    Nunez TC, Voskresensky IV, Dossett LA, Shinall R, Dutton WD, Cotton BA (2009) Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)? J Trauma 66(2):346–352CrossRefPubMedGoogle Scholar
  7. 7.
    Schroll R, Swift D, Tatum D, Couch S et al (2018) Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury 49(1):15–19CrossRefPubMedGoogle Scholar
  8. 8.
    Skelton T, Beno S (2017) Massive transfusion in pediatric trauma: we need to focus more on “how”. J Trauma Acute Care Surg 82(1):211–215CrossRefPubMedGoogle Scholar
  9. 9.
    Edwards MJ, Lustik MB, Clark ME, Creamer KM, Tuggle D (2015) The effects of balanced blood component resuscitation and crystalloid administration in pediatric trauma patients requiring transfusion in Afghanistan and Iraq 2002–2012. J Trauma 78(2):330–335CrossRefGoogle Scholar
  10. 10.
    Shroyer MC, Griffin RL, Mortellaro VE et al (2017) Massive transfusion in pediatric trauma: analysis of the national trauma databank. J Surg Res 220:52–58CrossRefPubMedGoogle Scholar
  11. 11.
    Hwu RS, Spinella PC, Keller MS et al (2016) The effect of massive transfusion implementation on pediatric trauma care. Transfusion 56(11):2712–2719CrossRefPubMedGoogle Scholar
  12. 12.
    Chidester SJ, Williams N, Wang W, Groner JI (2012) A pediatric massive transfusion protocol. J Trauma 73(5):1273–1277CrossRefGoogle Scholar
  13. 13.
    Hendrickson JE, Shaz BH, Pereira G et al (2012) Implementation of a pediatric trauma massive transfusion protocol: one institution’s experience. Transfusion 52(6):1228–1236CrossRefPubMedGoogle Scholar
  14. 14.
    Nosanov L, Inaba K, Okoye O et al (2013) The impact of blood product ratios in massively transfused pediatric trauma patients. Am J Surg 206(5):655–660CrossRefPubMedGoogle Scholar
  15. 15.
    Hansard SL, Sauberlich HE, Comar CL (1951) Blood volume of swine. Exp Biol Med 78(2):544–545CrossRefGoogle Scholar
  16. 16.
    Swindle MM (2010) Homeostasis models: hemorrhage shock models in swine. Sinclair Bioresources. http://www.sinclairresearch.com/assets/sites/2/Hemorrhagic-Shock-Models-in-Swine.pdf. Accessed 2 May 18
  17. 17.
    Neff L, Cannon J, Morrison J, Edwards MJ, Spinella P, Borgman M (2014) Clearly defining pediatric massive transfusion: cutting through the fog and friction with combat data. J Trauma 87:22–29Google Scholar
  18. 18.
    Riskin DA, Tsai TC, Riskin L et al (2009) Massive transfusion protocols: the role of aggressive resuscitation vs product ratio in mortality reduction. J Am Coll Surg 209(2):198–205CrossRefPubMedGoogle Scholar
  19. 19.
    Lee AC, Reduque LL, Luban NL et al (2014) Tranfusion-associated hyperkalemic cardiac arrest in pediatric patients receiving massive transfusion. Transfusion 54(1):244–254CrossRefPubMedGoogle Scholar
  20. 20.
    Schwaitzberg SD, Bergman KS, Harris BH (1988) A Pediatric trauma model of continuous hemorrhage. J Pediatr Surg 23(7):605–609CrossRefPubMedGoogle Scholar
  21. 21.
    Syverud SA, Dronen SC, Chudnofsky CR, van Ligten PF (1989) A continuous hemorrhage model of fatal hemorrhagic shock in swine. Resuscitation 17(3):287–295CrossRefPubMedGoogle Scholar
  22. 22.
    Boysen SR, Caulkett NA, Brookfield CE, Warren A, Pang JM (2016) Splenectomy vs. sham splenectomy in a swine model of controlled hemorrhagic shock. Shock 46(4):439–446CrossRefPubMedGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  1. 1.Department of SurgerySan Antonio Military Medical Center, Brooke Army Medical CenterSan AntonioUSA
  2. 2.Uniformed University of the Health SciencesBethesdaUSA

Personalised recommendations