scholarly journals Development of a porcine model of emergency resternotomy at a low-volume cardiac surgery centre

2020 ◽  
Vol 31 (6) ◽  
pp. 803-805
Author(s):  
Timothy M Guenther ◽  
Sarah A Chen ◽  
Joshua D Gustafson ◽  
Curtis J Wozniak ◽  
Bob Kiaii
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Porcine Model ◽  
Comfort Level ◽  
Large Animal Model ◽  
Large Animal ◽  
Training Environment ◽  
Life Saving ◽  
Simulation Scenario ◽  
Low Volume

Abstract Emergency resternotomy in the intensive care unit (ICU) is a rarely performed, yet potentially life-saving intervention. Success relies on recognition of a deteriorating clinical condition, timely deployment of equipment/personnel and rapid execution. Given how infrequently it is performed, we sought to develop a large animal model of resternotomy to prepare ICU nurses and technicians at our low-volume cardiac surgery military centre. A porcine model of resternotomy was developed at the end of an already-scheduled trauma lab. Participants worked their way through a pre-planned simulation scenario, culminating in the need for resternotomy. Pre-simulation surveys assessing knowledge and comfort level with aspects of resternotomy were compared to post-simulation surveys. Participants improved their knowledge of resternotomy by 20.4% (P < 0.0001; 14.7% for nurses and 26.9% for technicians). Improvements were seen in all aspects assessed relating to subjective comfort/preparedness of resternotomy. The model was an effective and realistic method to augment training of ICU staff about resternotomy. Costs associated with this model can be reduced when used in conjunction with large animal labs. This model should be used together with mannequin-based methods of resternotomy training to provide a realistic training environment and assessment of skills at capable institutions.

scholarly journals P1205ESTABLISHMENT OF HYPOCHLORITE-INDUCED PORCINE MODEL OF PERITONEAL FIBROSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Chun-Yuan Chao ◽  
Chin-Ho Wu ◽  
Yi-Ting Chen ◽  
SHUEI-LIONG LIN ◽  
Pei-Shiue Tsai
Keyword(s):  
Peritoneal Dialysis ◽  
Type I Collagen ◽  
Porcine Model ◽  
Large Animal Model ◽  
Large Animal ◽  
Type I ◽  
Peritoneal Fibrosis ◽  
Life Saving ◽  
Peritoneal Mesothelium ◽  
High Degree

Abstract Background and Aims Patients with kidney failure rely on life-saving peritoneal dialysis to facilitate waste exchange and maintain homeostasis of physical conditions. However, peritoneal dialysis often results in peritoneal fibrosis and organ adhesion that subsequently compromise the efficiency of peritoneal dialysis and normal functions of visceral organs. Despite rodent models provide clues on the pathogenesis of peritoneal fibrosis, no current large animal model which shares high degree of physiological and anatomical similarities to human is available, limiting their applications on the evaluation of pre-clinical therapeutic efficacy. Method In this study, we established for the first time, porcine model of peritoneal fibrosis by the use of a bleach-like chemical, sodium hypochlorite. We demonstrated that intraperitoneal injection of 30ml/kg B.W., 0.1%-0.2% (0.1mM-0.2mM) hypochlorite induced peritoneal fibrosis and visceral organ adhesions in 5-week-old piglets. Results A dose- and time-dependent severity of peritoneal fibrosis characterized by mesothelium fragmentation, αSMA+ myofibroblasts accumulation, organ surface thickening and type I collagen deposition were observed. We also demonstrated that hypochlorite-induced overexpression of IL1β, CX3CL1 and TGFβ on the peritoneal mesothelium mimicked the mechanism of peritoneal dialysis-induced peritoneal fibrosis in human patients. Conclusion This pig model could not only be used as a platform for studying fibrosis/scar formation, but can also be used to evaluate the efficacy of potential candidates on the prevention (e.g. compounds) and treatments (e.g. stem cells) for regenerative medicine.

Multiple stent delivery system Multi-LOC, a new technology for spot-stenting of the femoropopliteal artery – proof of concept study in a preclinical large animal model

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 446-451 ◽  
Author(s):  
Martin Sigl ◽  
Oliver Dudeck ◽  
Johannes Jung ◽  
Heinz Koelble ◽  
Klaus Amendt
Keyword(s):  
Delivery System ◽  
Porcine Model ◽  
New Technology ◽  
Large Animal Model ◽  
Lower Percentage ◽  
Stent Fracture ◽  
Large Animal ◽  
Neointimal Formation ◽  
Femoropopliteal Artery ◽  
Intraindividual Comparison

Abstract. Background: A new stent system was studied in a porcine model to evaluate its feasibility for spot-stenting of the femoropopliteal artery. Materials and methods: In a preliminary study in a single pig, handling and mechanical features of the novel multiple stent delivery system were tested. The Multi-LOC system demonstrated great feasibility regarding its pushability, trackability, and crossability. Excellent visibility of the individual stents allowed exact anatomically controlled implantation. In our main study, four to five short Multi-LOC stents (13 mm long) were implanted into the femoropopliteal arteries of six domestic pigs and long (60 to 100 mm) self-expandable nitinol stents were implanted into the same target vessel contralaterally to allow for intraindividual comparison. After four weeks survival under dual antiplatelet treatment, control angiography was performed. The animals were euthanized, stented vessels were explanted, and histologic sections were examined for the presence of neointimal formation. Results: Multi-LOC stents demonstrated no occlusion of the femoropopliteal axis (0 vs. 1 occlusion distal to a control stent), no stent fractures (0 out of 26 vs. 2 out of 6 control stents), and lower percentage diameter stenosis (0.564 ± 0.056 vs. 0.712 ± 0.089; p = 0.008) and length of stenosis (19.715 ± 5.225 vs. 39.397 ± 11.182; p = 0.007) compared to a standard control stent, which was similar in total length to the multiple stented artery segment. Histological examination confirmed myointimal hyperplasia underlying in-stent stenosis. Conclusions: The multiple stent delivery system was studied in a porcine model, which demonstrated its feasibility. Preclinical experience revealed favourable results concerning stent fracture, restenosis, and patency of spot-stented femoropopliteal arteries.

High-fidelity multiactor emergency preparedness training for patient care providers

2012 ◽  
Vol 7 (3) ◽  
pp. 175-188 ◽  
Author(s):  
Lancer A. Scott, MD ◽  
P. Tim Maddux, BS ◽  
Jennifer Schnellmann, PhD, ELS ◽  
Lauren Hayes, BS ◽  
Jessica Tolley, BS ◽  
...  
Keyword(s):  
Patient Care ◽  
Emergency Preparedness ◽  
Professional Training ◽  
The United States ◽  
Comfort Level ◽  
High Fidelity ◽  
Care Providers ◽  
Training Environment ◽  
Life Saving ◽  
The Impact

Background: Providing comprehensive emergency preparedness training (EPT) for patient care providers is important to the future success of emergency preparedness operations in the United States. Disasters are rare, complex events involving many patients and environmental factors that are difficult to reproduce in a training environment. Few EPT programs possess both competency-driven goals and metrics to measure life-saving performance during a multiactor simulated disaster.Methods: The development of an EPT curriculum for patient care providers—provided first to medical students, then to a group of experienced disaster medical providers—that recreates a simulated clinical disaster using a combination of up to 15 live actors and six high-fidelity human simulators is described. Specifically, the authors detail the Center for Health Professional Training and Emergency Response’s (CHPTER’s) 1-day clinical EPT course including its organization, core competency development, medical student self-evaluation, and course assessment.Results: Two 1-day courses hosted by CHPTER were conducted in a university simulation center. Students who completed the course improved their overall knowledge and comfort level with EPT skills.Conclusions: The authors believe this is the first published description of a curriculum method that combines high-fidelity, multiactor scenarios to measure the life-saving performance of patient care providers utilizing a clinical disaster scenario with 10 patients at once. A larger scale study, or preferably a multicenter trial, is needed to further study the impact of this curriculum and its potential to protect provider and patient lives.

scholarly journals 2411

2017 ◽  
Vol 1 (S1) ◽  
pp. 65-65 ◽  
Author(s):  
Nakesha King ◽  
Victoria Pepper ◽  
Cameron Best ◽  
Ekene Onwuka ◽  
Chengyu Li ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Three Dimensional ◽  
Large Animal Model ◽  
Large Animal ◽  
Promising Technique ◽  
Cfd Simulations ◽  
Life Saving ◽  
Study Population ◽  
Computational Fluid Dynamics Cfd

OBJECTIVES/SPECIFIC AIMS: Tissue engineered tracheal grafts (TETG) could provide a life-saving cure for children with long segment airway defects. Computational fluid dynamics (CFD) is a novel and promising technique used to evaluate TETG performance. This pilot study examines the correlation of objective CFD simulations with subjective respiratory symptoms in a TETG large animal model. METHODS/STUDY POPULATION: Three-dimensional geometries of 1 TETG implanted sheep trachea were reconstructed from serial fluoroscopic images, allowing analysis with CFD simulations. Peak flow velocity (PFV) and peak wall shear stress (PWSS) across the graft as well as changes secondary to stenting were determined. CFD metrics were compared with respiratory symptoms seen on exam. RESULTS/ANTICIPATED RESULTS: Two weeks after implantation, the animal developed respiratory distress, which correlated with PFV and PWSS elevations. Although the intraluminal graft appearance changed minimally after dilation, PFV and PWSS decreased across the graft (4.5–0.8 m/s and 0.9–0.1 Pa, respectively). Long-term TETG stenting with dilation returned PFV and PWSS to baseline (0.8–0.3 m/s and 0.1–0.01 Pa, respectively), which correlated with immediate symptom resolution. DISCUSSION/SIGNIFICANCE OF IMPACT: CFD is a noninvasive modality, which allows the evaluation of airflow metrics of symptomatic TETG recipients. This diagnostic tool will permit planned interventions and graft design optimization.

scholarly journals Development of a large animal model of lethal polytrauma and intra-abdominal sepsis with bacteremia

2021 ◽  
Vol 6 (1) ◽  
pp. e000636
Author(s):  
Rachel L O'Connell ◽  
Glenn K Wakam ◽  
Ali Siddiqui ◽  
Aaron M Williams ◽  
Nathan Graham ◽  
...  
Keyword(s):  
Animal Model ◽  
Porcine Model ◽  
Survival Curve ◽  
Abdominal Sepsis ◽  
Injury Pattern ◽  
Long Bone ◽  
Large Animal Model ◽  
Therapeutic Drug ◽  
Large Animal ◽  
Term Survival

BackgroundTrauma and sepsis are individually two of the leading causes of death worldwide. When combined, the mortality is greater than 50%. Thus, it is imperative to have a reproducible and reliable animal model to study the effects of polytrauma and sepsis and test novel treatment options. Porcine models are more translatable to humans than rodent models due to the similarities in anatomy and physiological response. We embarked on a study to develop a reproducible model of lethal polytrauma and intra-abdominal sepsis, which was lethal, though potentially salvageable with treatment.MethodsOur laboratory has a well-established porcine model that was used as the foundation. Animals were subjected to a rectus crush injury, long bone fracture, liver and spleen laceration, traumatic brain injury and hemorrhage that was used as a foundation. We tested various colon injuries to create intra-abdominal sepsis. All animals underwent injuries followed by a period of shock, then subsequent resuscitation.ResultsAll animals had blood culture-proven sepsis. Attempts at long-term survival of animals after injury were ceased because of poor appetite and energy. We shifted to an 8-hour endpoint. The polytrauma injury pattern remained constant and the colon injury pattern changed with the intention of creating a model that was ultimately lethal but potentially salvageable with a therapeutic drug. An uncontrolled cecal injury (n=4) group resulted in very early deaths. A controlled cecal injury (CCI; n=4) group had prolonged time prior to mortality with one surviving to the endpoint. The sigmoid injury (n=5) produced a similar survival curve to CCI but no animals surviving to the endpoint.ConclusionWe have described a porcine model of polytrauma and sepsis that is reproducible and may be used to investigate novel treatments for trauma and sepsis.Level of evidenceNot applicable. Animal study.

Interacting risk factors determine the outcome of patients with a prolonged intensive care unit stay after cardiac surgery

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
J Schöttler ◽  
C Grothusen ◽  
T Attmann ◽  
C Friedrich ◽  
S Freitag-Wolf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay

Survival after cardiac surgery and long-term intensive care unit stay

2013 ◽  
Vol 61 (S 01) ◽  
Author(s):  
C Schimmer ◽  
K Hamouda ◽  
M Özkur ◽  
SP Sommer ◽  
I Aleksic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Intensive Care Unit Stay
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