Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock?

PURPOSE: The aim of this study is to evaluate the early survival and organ damage following 30 and 60 min of thoracic resuscitative endovascular balloon occlusion of the aorta (REBOA) in an ovine model of severe hemorrhagic shock. METHODS: Eighteen sheep were induced into shock by undergoing a 35 % controlled exsanguination over 30 min. Animals were randomized into three groups: 60-min REBOA 30 min after the bleeding (60-REBOA), 30-min REBOA 60 min after the bleeding (30-REBOA) and no-REBOA control (n-REBOA). Resuscitation with crystalloids and whole blood was initiated 20 and 80 min after the induction of shock. Animals were observed for 24 h with serial potassium and lactate measurements. Autopsy was performed to evaluate organ damage. RESULTS: Two animals of the n-REBOA group died within 90 min of shock induction; no hemorrhagic deaths were observed in the REBOA groups. Twenty-four-hour survival for the 60-, 30-, and n-REBOA groups was 0/6, 5/6, and 4/6 (P = 0.002). In 60-REBOA, potassium and lactate were increased at 270-min time point: from 4.3 to 5.1 mEq/l and from 3.7 to 5.1 mmol/L, respectively. Both these values were significantly higher than in the n-REBOA group (P = 0.029 for potassium and P = 0.039 for lactate). Autopsy revealed acute tubular necrosis in all died REBOA group animals. CONCLUSIONS: In this ovine model of severe hemorrhagic shock, REBOA can be used to prevent early death from hemorrhage; however, 60 min of occlusion results in significant metabolic derangement and organ damage that offsets this gain.

[Modern problems and main ways of imorovement of disinfecting art in Armed Forces].

The article states the reasons defining the high relevance and significance of disinfection measures in modern conditions, reports general and specific problems of ensuring disinfection during medical service day-to-day activities. The directions of development of chemical and technical disinfectants and methods for'their use on different objects and under various climatic conditions are determined. It was shown that the crucial condition for implementation of theoretical and practical ways of improving disinfection affairs is a comprehensive approach based on concerted efforts of all authorities of Russian Armed Forces Medical Services, research and sanitary-epidemiological institutions, as well as relevant chars of the Military Medical Academy in close cooperation with representatives of domestic industry.

[Administration of Palonosetron and Phenotropil for Prophylaxis of the N-V-D Stage of Acute Radiation Syndrome].

Experiments on small (rats) and large (dogs) animals have shown that a sequential administration of Palonosetron and Phenotropil decreases the intensity of the main manifestations of the N-V-D stage of acute radiation syndrome. These data show the appropriateness of a combined administration of Palonosetron and Phenotropil to prevent a reduced work capacity in the individuals participating in elimination of the consequences of accidents associated with overexposure to radiation.

[Use of the tactics of multistage surgical treatment on the model of combined radiation-and-mechanic injury].

Use of the tacticts of multistage surgical treatment on the model of combined radiation-and-mechanic injury. The article provides information on the use of the tactics of multistage surgical treatment (MST), which allows increasing survival value in patients with polytrauma. There are no descriptions of possibility of the use of this tactics in case of combined radiation-and-mechanic injuries in available literature. During an experimental research underwent on 25 sheep it was found that in case of MST implementation there is a significant decrease of intraoperative and postoperative lethal outcome in comparison with traditional tactics. In animals, underwent MST, were defined more laudable course of radiation syndrome. Analysis of laboratory peripheral blood indexes allowed making conclusion, that conducting final surgical intervention (3'd stage of MST) during the first 24 hours after abbreviated surgical intervention allows finishing surgical treatment and intensive care before the beginning of acute radiation syndrome and doesn't counter classic recommendations concerning the treatment of combined radiation-and-mechanic injuries.

[Prehospital care in extremity major vascular injuries].

The problem of temporary hemorrhage control is one of the most important issues of modern war surgery and surgery of trauma. It is a review of literature devoted to prehospital care in extremity major vascular injuries, embraced up-to-date domestic materials as well as the modern foreign papers in this area. The most important historical landmarks of temporary hemorrhage control system are considered. We paid special attention to the most usable methods and means of hemorrhage control which are utilized at the modern time: pressure bandages, tourniquets, local haemostatic agents. The comprehensive analysis of the contamporary haemostatic means concerning U.S. Army has done. The experience of foreign colleagues in development of prehospital care for the injured, creation and progress of new haemostatic methods, application of temporary hemorrhage control system is analyzed.