Development of a post-mortem human specimen flow model for advanced bleeding control training. Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Vrancken, Suzanne M.; Borger van der Burg, Boudewijn L.S.; Stark, Pieter W.; van Waes, Oscar J.F.; DuBose, Joseph J.; Benjamin, Elizabeth R.; Lieber, André; Verhofstad, Michael H.J.; Kleinrensink, Gert-Jan; Hoencamp, Rigo
• Is Part Of: Injury. Volume 54:Issue 1(2023)
• Page Start: 214
• Page End: 222
• Publication Date: 2023-01
• Subjects: Bleeding control -- Training -- Perfusion -- Human cadaver -- Flow model; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.07.051
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: It is feasible to create a fully perfused human specimen model with circulating arterial and venous flow via a single arterial inflow cannula. This perfused human flow model can be used in trauma scenario training for realistic training of advanced bleeding control techniques. The use of AnubiFiX embalmed human specimen has the advantage of reusability while preserving color, flexibility, and suppleness of the tissues. Regional arteriovenous flow can be used to reduce the development of tissue edema and increase the durability of the flow model. 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.