Vagus nerve stimulation improves coagulopathy in hemorrhagic shock: a thromboelastometric animal model study

Journal of Trauma Management & Outcomes

Jose Cunha-Melo¹  Sandro B Rizoli²  Marcus Andrade¹  Christopher Kushmerick¹  Cyntia Trant¹  Thiago Almeida¹  Mario Carvalho¹  Roger Lage Alves¹  Joao B Rezende-Neto² 

[1] Federal University of Minas Gerais, Belo Horizonte, Brazil;Department of General Surgery, St. Michael’s Hospital - University of Toronto, Toronto, ON, Canada

关键词: Thromboelastometry;    Cytokines;    Vagal nerve;    Coagulopathy;    Trauma;    Resuscitation;    Shock;    Hemorrhage;   

Others  :  1132876
DOI  :  10.1186/1752-2897-8-15

 received in 2014-07-14, accepted in 2014-09-12,  发布年份 2014

【 摘 要 】

Introduction

Inflammation plays a major role in the multifactorial process of trauma associated coagulopathy. The vagus nerve regulates the cholinergic anti-inflammatory pathway. We hypothesized that efferent vagus nerve stimulation (VNS) can improve coagulopathy by modulating the inflammatory response to hemorrhage.

Methods

Wistar rats (n = 24) were divided in 3 groups: Group (G1) Sham hemorrhagic shock (HS); (G2) HS w/o VNS; (G3) HS followed by division of the vagus nerves and VNS of the distal stumps. Hemorrhage (45% of baseline MAPx15 minutes) was followed by normotensive resuscitation with LR. Vagus nerves were stimulated (3.5 mA, 5 Hz) for 30 sec 7 times. Samples were obtained at baseline and at 60 minutes for thromboelastometry (Rotem®) and cytokine assays (IL-1 and IL-10). ANOVA was used for statistical analysis; significance was set at p < 0.05.

Results

Maximum clot firmness (MCF) significantly decreased in G2 after HS (71.5 ± 1.5 vs. 64 ± 1.6) (p < 0.05). MCF significantly increased in G3 compared to baseline (67.3 ± 2.7 vs. 71.5 ± 1.2) (p < 0.05). G3 also showed significant improvement in Alfa angle, and Clot Formation Time (CFT) compared to baseline. IL-1 increased significantly in group 2 and decrease in group 3, while IL-10 increased in group 3 (p < 0.05).

Conclusions

Electrical stimulation of efferent vagus nerves, during resuscitation (G3), decreases inflammatory response to hemorrhage and improves coagulation.

【 授权许可】

   
2014 Rezende-Neto et al.; licensee BioMed Central Ltd.

【 图 表 】

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