Spotlight on animal models of acute traumatic coagulopathy: an update

Ask, Antje; Eltringham-Smith, Louise J.; Bhakta, Varsha; Donkor, David A.; Pryzdial, Edward L. G.; Sheffield, William P.

doi:10.1016/j.transci.2022.103412

Cited by 8 publications

(6 citation statements)

References 71 publications

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“…The review focused on human studies conducted in trauma patients with severe bleeding. It should be noted that animal models play important roles in traumatic hemorrhage and resuscitation research [ 19 , 20 ] and AI/ML techniques have been applied in animal models of hemorrhage [ 21 – 23 ], which deserves further investigation. Studies in burns were excluded given a recent review on this topic [ 24 ].…”

Section: Search Strategy Selection and Inclusion Criteriamentioning

confidence: 99%

Artificial intelligence and machine learning for hemorrhagic trauma care

et al. 2023

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Artificial intelligence (AI), a branch of machine learning (ML) has been increasingly employed in the research of trauma in various aspects. Hemorrhage is the most common cause of trauma-related death. To better elucidate the current role of AI and contribute to future development of ML in trauma care, we conducted a review focused on the use of ML in the diagnosis or treatment strategy of traumatic hemorrhage. A literature search was carried out on PubMed and Google scholar. Titles and abstracts were screened and, if deemed appropriate, the full articles were reviewed. We included 89 studies in the review. These studies could be grouped into five areas: (1) prediction of outcomes; (2) risk assessment and injury severity for triage; (3) prediction of transfusions; (4) detection of hemorrhage; and (5) prediction of coagulopathy. Performance analysis of ML in comparison with current standards for trauma care showed that most studies demonstrated the benefits of ML models. However, most studies were retrospective, focused on prediction of mortality, and development of patient outcome scoring systems. Few studies performed model assessment via test datasets obtained from different sources. Prediction models for transfusions and coagulopathy have been developed, but none is in widespread use. AI-enabled ML-driven technology is becoming integral part of the whole course of trauma care. Comparison and application of ML algorithms using different datasets from initial training, testing and validation in prospective and randomized controlled trials are warranted for provision of decision support for individualized patient care as far forward as possible.

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Section: Search Strategy Selection and Inclusion Criteriamentioning

confidence: 99%

Artificial intelligence and machine learning for hemorrhagic trauma care

et al. 2023

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“…Impaired coagulation and fibrinolysis following traumatic injury, a clinical phenomenon termed trauma-induced coagulopathy (TIC), have been observed for decades, with temporal changes in coagulation following severe trauma first clinically documented and reported in the 1960s [ 11 , 12 , 13 ]. TIC denotes a spectrum of clotting abnormalities or phenotypes that range from hypocoagulability and hyperfibrinolysis in the early stages of trauma (“early” TIC; within 6 h of injury), resulting in potentially fatal bleeding, to hypercoagulability and fibrinolysis suppression in the later stages (“late” TIC; 24 h after the injury), leading to multiple organ failure and death [ 11 , 12 , 14 , 15 , 16 ]. Early coagulopathy can develop because of resuscitation with large volumes of cold fluids, which have dilution and hypothermic effects on coagulation factors [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Experimental Models of Traumatic Injuries: Do They Capture the Coagulopathy and Underlying Endotheliopathy Induced by Human Trauma?

Barrett

Curry

Abu-Hanna

2023

IJMS

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Trauma-induced coagulopathy (TIC) is a major cause of morbidity and mortality in patients with traumatic injury. It describes the spectrum of coagulation abnormalities that occur because of the trauma itself and the body’s response to the trauma. These coagulation abnormalities range from hypocoagulability and hyperfibrinolysis, resulting in potentially fatal bleeding, in the early stages of trauma to hypercoagulability, leading to widespread clot formation, in the later stages. Pathological changes in the vascular endothelium and its regulation of haemostasis, a phenomenon known as the endotheliopathy of trauma (EoT), are thought to underlie TIC. Our understanding of EoT and its contribution to TIC remains in its infancy largely due to the scarcity of experimental research. This review discusses the mechanisms employed by the vascular endothelium to regulate haemostasis and their dysregulation following traumatic injury before providing an overview of the available experimental in vitro and in vivo models of trauma and their applicability for the study of the EoT and its contribution to TIC.

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“…Rodent models, despite husbandry and cost benefits, are of limited use in trauma research due to their low blood volumes (precluding sequential sampling, especially on a background of hemorrhage) and clinically relevant anatomical differences compared to humans. Larger animal species, such as pigs, address these issues and are therefore among the most frequently reported large animal trauma model 5 …”

Section: Introductionmentioning

confidence: 99%

“…Larger animal species, such as pigs, address these issues and are therefore among the most frequently reported large animal trauma model. 5 Our research group has developed a porcine model of severe traumatic injury and haemorrhagic shock to investigate the temporal profiles of microcirculatory (dys)function following injury, shock and resuscitation. Various groups have conducted sublingual videomicroscopy in pigs or humans independently; however, a direct comparison between the species has not been reported.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of sublingual microcirculatory parameters measured by sidestream darkfield videomicroscopy in anesthetized pigs and adult humans

Lala,

Homes,

Pratt

et al. 2023

Anim Models and Exp Med

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BackgroundThis study aimed to compare sublingual microcirculatory parameters between anesthetized pigs and conscious adult humans using sidestream darkfield videomicroscopy. The overarching aim of the work was to validate the pig as an experimental model of changes in microcirculatory function following traumatic haemorrhagic shock and resuscitation.MethodsFourteen large white pigs and 14 humans were recruited for the study. Sublingual sidestream darkfield videomicroscopy clips were captured in anesthetized pigs and conscious humans. Clips underwent manual analysis in Automated Vascular Analysis 3.2 software. The total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPVs) and microvascular flow index (MFI) were quantified. An independent samples t test was used for between species comparison of microcirculatory parameters.Results and ConclusionsConscious humans had a significantly lower TVD, PVD and MFI than anesthetized pigs. No significant difference in PPVs was observed between the species. Perfusion of the microcirculation is a critical determinant of tissue metabolic function and viability. Whilst it may not be surprising that some interspecies differences in the sublingual microcirculatory anatomy were identified between pig and human subjects, it is interesting to report the insignificant difference in PPVs. This direct microcirculatory measure represents a relative change which should hold translatable value across species. We therefore conclude the pig is a suitable model for microcirculatory research and may be a suitable species to investigate changes in microcirculatory perfusion following perturbations in cardiovascular homeostasis, for example during traumatic haemorrhagic shock and resuscitation.

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Spotlight on animal models of acute traumatic coagulopathy: an update

Cited by 8 publications

References 71 publications

Artificial intelligence and machine learning for hemorrhagic trauma care

Artificial intelligence and machine learning for hemorrhagic trauma care

Experimental Models of Traumatic Injuries: Do They Capture the Coagulopathy and Underlying Endotheliopathy Induced by Human Trauma?

Comparison of sublingual microcirculatory parameters measured by sidestream darkfield videomicroscopy in anesthetized pigs and adult humans

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