Page 83 - JSOM Winter 2021

FIGURE 5 Metabolic data for each of the three
hemorrhage volume groups including potassium
values (A–C) and lactate values (D–F).

vascular integrity have also been noted to subsequently cause constraints. This can help to delineate additional physiologic
remote changes in cardiac gap junctions, subcellular apopto- and kinematic thresholds for further multivariate analysis and
18
sis, and loss of function. While it could certainly be argued subsequent therapeutic trials.
that there was potential blunt cardiac injury, the initial evi-
dence of cardiac responsiveness to hemorrhage in accordance Disclosures
with loss of preload as manifest by increases in systemic vas- The authors have indicated they have no financial relation-
cular resistance and contractility argues against this premise. ships relevant to this article to disclose.
We also found increased extracellular potassium, a normally
intracellular cation, as hemorrhage proceeded, suggesting a Conflicts of Interest
surrogate for ongoing apoptosis. None.

This study is limited by the small sample size, however the Author Contributions
results do still demonstrate differential survival characteris- HA, NP, JE, MJR, and JJM conceived the study concept. HA,
tics between groups as well as distinctive hemodynamic and NP, JE, MJR, JD, and DP conducted experiments and collected
metabolic patterns. We also did not include a nonhemorrhage the data. NE and JD analyzed the data. HA and DP wrote
comparator group to this particular model. However, the use the manuscript. JJM was primarily responsible for critical re-
of multiple injury patterns alone has already been demon- visions. All authors read and approved the final manuscript.
strated to be an independent predictor of poor outcomes, re-
gardless of ISS. In particular, it has been shown with the use of References
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in Afghanistan: lessons for civil systems? Curr Opin Crit Care.
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characterize a polytrauma and hemorrhagic shock model in 3. Stannard A, Morrison JJ, Scott DJ, et al. The epidemiology of non-
the absence of fluid resuscitation and the components therein. compressible torso hemorrhage in the wars in Iraq and Afghani-
The data suggested the optimal model in this study would in- stan. J Trauma Acute Care Surg. 2013;74(3):830–844.
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made by individual researchers to suit their individual needs. 3-sulfate for severe hemorrhage in minipigs in the absence of fluid
resuscitation: J Trauma Acute Care Surg. 2014;76(6):1409–1416.
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differential survival of the various hemorrhage volumes con- trauma in a long-term porcine model of severe multiple trauma. Sci
tribute to the titratability and reproducibility of the model. Rep. 2016;6:39659.
This model allows for the capture of multiple hemodynamic 7. Eschbach D, Steinfeldt T, Hildebrand F, et al. A porcine poly-
trauma model with two different degrees of hemorrhagic shock:
and metabolic parameters which can help to expand the AIS outcome related to trauma within the first 48 h. Eur J Med Res.
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