A systematic review of large animal models of combined traumatic brain injury and hemorrhagic shock

Mayer, A. R. and Dodd, A. B. and Vermillion, M. S. and Stephenson, D. D. and Chaudry, I. H. and Bragin, D. E. and Gigliotti, A. P. and Dodd, R. J. and Wasserott, B. C. and Shukla, P. and Kinsler, R. and Alonzo, S. M.

Neurosci Biobehav Rev (2019) 104: 160–177

DOI: 10.1016/j.neubiorev.2019.06.024

Abstract

Traumatic brain injury (TBI) and severe blood loss (SBL) frequently co-occur in human trauma, resulting in high levels of mortality and morbidity. Importantly, each of the individual post-injury cascades is characterized by complex and potentially opposing pathophysiological responses, complicating optimal resuscitation and therapeutic approaches. Large animal models of poly-neurotrauma closely mimic human physiology, but a systematic literature review of published models has been lacking. The current review suggests a relative paucity of large animal poly-neurotrauma studies (N = 52), with meta-statistics revealing trends for animal species (exclusively swine), characteristics (use of single biological sex, use of juveniles) and TBI models. Although most studies have targeted blood loss volumes of 35-45%, the associated mortality rates are much lower relative to Class III/IV human trauma. This discrepancy may result from potentially mitigating experimental factors (e.g., mechanical ventilation prior to or during injury, pausing/resuming blood loss based on physiological parameters, administration of small volume fluid resuscitation) that are rarely associated with human trauma, highlighting the need for additional work in this area.

Citation

Mayer, A. R., Dodd, A. B., Vermillion, M. S., Stephenson, D. D., Chaudry, I. H., Bragin, D. E., Gigliotti, A. P., Dodd, R. J., Wasserott, B. C., Shukla, P., Kinsler, R., & Alonzo, S. M. (2019). A systematic review of large animal models of combined traumatic brain injury and hemorrhagic shock. Neurosci Biobehav Rev, 104, 160–177. https://doi.org/10.1016/j.neubiorev.2019.06.024 Animals, *Disease Models, Animal, *Traumatic brain injury, *Brain Injuries, Traumatic, *Common Data Elements, *Hypovolemia, *Large animal models, *Poly-neurotrauma, *Shock, *Shock, Hemorrhagic

Keywords

• Animals
• *Disease Models
• Animal
• *Traumatic brain injury
• *Brain Injuries
• Traumatic
• *Common Data Elements
• *Hypovolemia
• *Large animal models
• *Poly-neurotrauma
• *Shock
• *Shock
• Hemorrhagic