Development of a post-mortem human specimen flow model for advanced bleeding control training

Injury, vol. 54, pp. 214–222

Abstract

INTRODUCTION: Prompt and effective hemorrhage control is paramount to improve survival in patients with catastrophic bleeding. In the ever-expanding field of bleeding control techniques, there is a need for a realistic training model to practice these life-saving skills. This study aimed to create a realistic perfused post-mortem human specimen (PMHS) flow model that is suitable for training various bleeding control techniques. MATERIALS AND METHODS: This laboratory study was conducted in the SkillsLab & Simulation Center of Erasmus MC, University Medical Center Rotterdam, the Netherlands. One fresh frozen and five AnubiFiX® embalmed PMHS were used for the development of the model. Subsequent improvements in the exact preparation and design of the flow model were made based on model performance and challenges that occurred during this study and are described. RESULTS: Circulating arteriovenous flow with hypertonic saline was established throughout the entire body via inflow and outflow cannulas in the carotid artery and jugular vein of embalmed PMHS. We observed full circulation and major hemorrhage could be mimicked. Effective bleeding control was achieved by placing a resuscitative endovascular balloon occlusion of the aorta (REBOA) catheter in the model. Regional perfusion significantly reduced the development of tissue edema. CONCLUSION: Our perfused PMHS model with circulating arterial and venous flow appears to be a feasible method for the training of multiple bleeding control techniques. Regional arteriovenous flow successfully reduces tissue edema and increases the durability of the model. Further research should focus on reducing edema and enhancing the durability of the model.

Authors 10

1. Suzanne M. Vrancken corresponding Aachen Department of Surgery, Alrijne Hospital

   Erasmus MC · Alrijne Ziekenhuis · Erasmus University Rotterdam

   Affiliation as printed

   Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: smvrancken@alrijne.nl

   Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

2. Boudewijn L. S. Borger van der Burg Aachen Department of Surgery, Alrijne Hospital

   Alrijne Ziekenhuis

   Affiliation as printed

   Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

3. Pieter W. Stark

   Erasmus MC

   Affiliation as printed

   Surgical SkillsLab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

4. Oscar J.F. Van Waes

   Erasmus MC · Ministry of Defence

   Affiliation as printed

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands

   Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

5. Joseph Jeremy DuBose

   University of Maryland, Baltimore

   Affiliation as printed

   R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA

6. Elizabeth Benjamin

   Grady Memorial Hospital · Emory University

   Affiliation as printed

   Department of Surgery, Trauma/Surgical Critical Care Division, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA

7. André Lieber

   Bundeswehrkrankenhaus · Bundeswehr

   Affiliation as printed

   Department of General, Visceral and Thoracic Surgery, Bundeswehr Hospital Berlin, Berlin, Germany

8. M.H.J. Verhofstad

   Erasmus MC

   Affiliation as printed

   Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

9. Gert‐Jan Kleinrensink

   Erasmus MC · Erasmus University Rotterdam

   Affiliation as printed

   Surgical SkillsLab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

   Department of Neuroscience and Anatomy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

   Surgical SkillsLab, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands

10. Rigo Hoencamp Aachen Department of Surgery, Alrijne Hospital Department of Surgery, Leiden University Medical Centre

    Leiden University · Leiden University Medical Center · Erasmus MC · Ministry of Defence · Alrijne Ziekenhuis

    Affiliation as printed

    Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands; Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands; Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

    Defense Healthcare Organization, Ministry of Defense, Utrecht, the Netherlands

    Department of Surgery, Alrijne Hospital, Leiderdorp, the Netherlands

    Department of Surgery, Leiden University Medical Centre, Leiden, the Netherlands

    Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands