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首页> 外文期刊>The Internet Journal of Medical Simulation >Development of a Perfused Cadaver Model of Exsanguinating Hemorrhage for Procedural Training and Device Evaluation
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Development of a Perfused Cadaver Model of Exsanguinating Hemorrhage for Procedural Training and Device Evaluation

机译：用于过程训练和设备评估的失血性灌注尸体模型的开发

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Introduction: We demonstrate a novel perfused cadaver model with realistic tissue feel, true anatomy, and replicating key local physiologic parameters of acute life-threatening hemorrhage. Validation of fidelity is accomplished through measurement of hemodynamics and video confirmation of hemorrhage control.Methods: A pulsatile pump was attached to the ascending and descending aorta of a fresh or fresh-frozen cadaver via plastic tubing. The pump provided forward flow at 60 beats per minute of water with red coloring, simulating circulation. Flow probes were attached to arteries immediately proximal to an injury/transection site, with pressure probes cannulated in a contralateral artery that indicated systemic pressure. Hemorrhage control was performed using three different devices, with cessation of hemorrhage confirmed via physiologic data as well as visually.Results: Physiologic data confirmed that hemorrhage control was obtained under expected parameters. Flow immediately proximal to the injury site was negligible after hemorrhage control was attempted, while systemic pressure increased. When the hemorrhage control device was released, bleeding resumed and flow increased as measured proximal to the wound. Video recordings served as visual confirmation of hemorrhage control obtained using various devices.Conclusions: Our perfused cadaver model offers realistic tissue feel and simulated blood flow with a pulse, with hemorrhage control correlating to realistic physiologic parameters. The result is an accurate representation of visual, tactile, and physiologic modeling for acute life-threatening limb hemorrhage control. Introduction Simulation is integral both for task training and for comprehensive training in emergency care and resuscitation, and several platforms are in widespread use including high- and low-fidelity patient simulators (e.g., mannequins), animal models and human cadavers1-3. Each of the different platforms has particular characteristics that render them more or less suitable for certain types of training and procedures2-4. Visual realism, anatomic fidelity, tissue feel, cost, durability and other factors affect a model’s realism and effectiveness. For example, a model for cricothyrotomy should have high anatomic fidelity since proper placement is heavily dependent on anatomic landmarks. In contrast, a model used for extremity hemorrhage control should provide realistic bleeding that mimics the physiologic characteristics of real hemorrhage such as brisk flow rates, pulsatile pressures, and response to appropriate interventions. Recently, interest has focused on so-called perfused or dynamic cadavers. These are human cadavers that are prepared in such a way that fluid flows through blood vessels and vascular tissue “bleeds” realistically when traumatized. Aboud, et al have demonstrated the use of perfused cadavers in neurological, vascular, and trauma surgery5-7. They used an intra-aortic balloon pump to circulate a colored liquid, simulating blood, into the vasculature. The benefit of their model was the pulsatile bleeding and more realistic tissue feel with oozing. Although Aboud et al examined primarily surgical procedures, the same principles could be applied for other invasive procedures in which bleeding and tissue authenticity were required5-7. For example, Garrett, et al used a fresh-frozen cadaver model for endovascular device testing and training8. In this model a pump was attached to two ends of a section of vasculature to achieve a closed circuit around the area of interest. This allowed the participant to feel pulsatile flow in a realistic anatomy to achieve arterial access via catheters and deploy stents and balloons downstream. Not previously described, however, is a perfused cadaver model specifically intended for training emergency care procedures.We present a perfused cadaver as a training model for acute exsanguinating hemorrhage control. Our objective is to demonstrate visually and physiol
机译：简介：我们演示了一种新颖的灌注尸体模型，具有逼真的组织感觉，真实的解剖结构，并复制了危及生命的急性出血的关键局部生理参数。保真度的验证是通过测量血液动力学并通过视频确认出血控制来完成的。方法：通过塑料管将脉动泵连接到新鲜或新鲜冷冻尸体的升主动脉和降主动脉上。该泵以每分钟60拍的速度向水流提供红色，模拟循环。将流量探针连接到紧邻损伤/横断部位的动脉，压力探针插在对侧动脉中以指示全身压力。使用三种不同的设备进行出血控制，并通过生理数据和目视确认出血的停止。结果：生理数据证实在预期参数下可以进行出血控制。尝试控制出血后，紧邻损伤部位的流量可忽略不计，而全身压力升高。放开出血控制装置后，如在伤口近端测得的那样，出血重新开始，流量增加。视频记录可作为通过各种设备获得的出血控制的视觉确认。结论：我们的尸体灌注模型可提供真实的组织感觉和带有脉冲的模拟血流，而出血控制与真实的生理参数相关。结果是视觉，触觉和生理模型的精确表示，可用于急性威胁生命的肢体出血控制。简介模拟是任务培训以及急救和复苏方面综合培训不可或缺的一部分，并且广泛使用了多种平台，包括高保真和低保真度的患者模拟器（例如人体模型），动物模型和人体尸体1-3。每个不同的平台都有其特定的特征，使其或多或少地适合于某些类型的培训和规程2-4。视觉真实感，解剖学逼真度，组织感觉，成本，耐用性和其他因素会影响模型的真实感和有效性。例如，因为正确放置在很大程度上取决于解剖标志，所以环切开术的模型应具有较高的解剖保真度。相反，用于四肢出血控制的模型应提供逼真的出血，该出血模仿真实的出血的生理特征，例如轻快的流速，脉动压力以及对适当干预措施的反应。近来，人们的兴趣集中在所谓的灌注或动态尸体上。这些是人体尸体，其制备方式是使液体在受到创伤时实际上流过血管，并且血管组织“渗出”。 Aboud等人证明了灌注尸体在神经，血管和创伤手术中的使用5-7。他们使用了主动脉内球囊泵将有色液体（模拟血液）循环到脉管系统中。他们的模型的好处是搏动性出血和渗出时更真实的组织感觉。尽管Aboud等人主要研究了外科手术，但相同的原理也可用于需要出血和组织真实性的其他侵入性手术5-7。例如，Garrett等人将新鲜冷冻的尸体模型用于血管内装置测试和培训8。在该模型中，将泵连接到脉管系统部分的两端，以实现目标区域周围的闭合回路。这使参与者能够在现实的解剖结构中感觉到脉动血流，从而通过导管实现动脉通路，并在下游部署支架和球囊。但是，以前没有介绍过专门用于培训急救程序的灌注尸体模型。我们提出了一种灌注尸体作为急性放血控制的训练模型。我们的目标是在视觉和生理上展示

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