Development and description of a porcine model of combat casualty care for traumatic-hemorrhagic shock research and medical training.
Venetia Cardona, Frédérique Dufour-Gaume, Florent Montespan, Audrey Bordone, Nicolas J Prat
European journal of trauma and emergency surgery : official publication of the European Trauma Society May 22, 2025 DOI: 10.1007/s00068-025-02892-w (opens in new tab) via PubMed
Summary
AI-generated from the abstractMost animal models of hemorrhagic shock with multiple injuries only reproduce soft tissue damage, limiting their relevance to battlefield trauma. In a pig model of combat-related hemorrhagic shock plus bilateral femur fractures, three anesthetics were compared: ketamine-midazolam (KM), isoflurane (ISO), and alfaxalone (ALFA). Both KM and ISO produced hemodynamic changes typical of severe shock, while ALFA caused extreme, persistent tachycardia even after resuscitation, indicating poor tolerance. The authors conclude that ALFA is unsuitable for this model, whereas KM and ISO are both appropriate, with KM being most clinically relevant for prehospital or austere military medical care.
Study at a glance
| Characteristics | Randomized controlled trial Peer reviewed |
|---|---|
| Sample size | 19 |
| Population | Pigs |
| Interventions | Ketamine-midazolam Isoflurane Alfaxalone |
| Keywords | Combat medicine Military healthcare Anesthesia Combat casualty care Hemorrhagic shock |
| Key finding | Ketamine-midazolam and isoflurane are suitable anesthetics for a porcine model of combat-related hemorrhagic shock with polytrauma, whereas alfaxalone is not due to poor hemodynamic tolerance. |
Abstract
Despite the high incidence of death among cases of hemorrhagic shock associated with polytrauma, few animal models are representative of this combined type of aggression, as most essentially reproduce soft tissue injury. To improve trauma research and its applicability to battlefield situations, appropriate animal models simulating battlefield trauma care must be defined. As anesthesia itself influences physiological and hemodynamic variables, we studied three different types of anesthesia, ketamine-midazolam (KM), isoflurane (ISO), and alfaxalone (ALFA), in a porcine model of combat-related hemorrhagic shock injury. A total of 19 pigs were randomized to the KM (n = 5), ISO (n = 6), and ALFA (n = 8) groups and subjected to a hemorrhagic shock associated with bilateral femoral fractures and delayed resuscitation. The combined traumatic insult with severe hemorrhage resulted in characteristic signs of severe shock. The KM and ISO groups were representative of the hemodynamic perturbation of hemorrhagic shock, whereas the ALFA group showed signs of low tolerance, with extreme and persistent tachycardia even after resuscitation. We concluded that ALFA was not the most suitable anesthetic for our hemodynamically compromised model and that KM or ISO were two relevant anesthesia regiments to study traumatic-hemorrhagic shock in pigs. However, KM was the most clinically relevant to medical practices in prehospital medical care or an austere environment.