Coagulopathy implications using a multiscale model of traumatic bleeding matching macro and microcirculation.

Authors:
Talid Sinno
Talid Sinno
University of Pennsylvania
United States
Scott Diamond
Scott Diamond
University of Pennsylvania
United States

Am J Physiol Heart Circ Physiol 2019 Apr 12. Epub 2019 Apr 12.

University of Pennsylvania, 394 Town Building, United States.

Quantifying the relationship between vascular injury and the dynamic bleeding rate requires a multiscale model that accounts for changing and coupled hemodynamics between the global and microvascular levels. A lumped, global hemodynamic model of the human cardiovascular system with baroreflex control was coupled to a local 24-level bifurcating vascular network that spanned diameters from the muscular artery scale (0.1 - 1.3 mm) to capillaries (5-10 μm) via conservation of momentum and conservation of mass boundary conditions. For defined injuries of severing all vessels at each n-level, the changing pressures and flowrates were calculated using prescribed shear-dependent hemostatic clot growth rates (normal or coagulopathic). Key results were: (1) the upstream vascular network rapidly depressurizes to reduce blood loss, (2) wall shear rates at the hemorrhaging wound exit are sufficiently high (~10,000 s) to drive von Willebrand Factor unfolding, (3) full coagulopathy results in >2L blood loss in 2 hours for severing all vessels of 0.13 to 0.005 mm diameter within the bifurcating network, whereas full hemostasis limits blood loss to <100 mL within 2 min, and (4) hemodilution from transcapillary refill increases blood loss and could be implicated in trauma induced coagulopathy. A sensitivity analysis on length/diameter ratio and branching exponent demonstrated that bleeding was strongly dependent upon these tissue-dependent network parameters. This is the first bleeding model that prescribes the geometry of the injury in order to calculate the rate of pressure-driven blood loss and local wall shear rate in the presence or absence of coagulopathic blood.

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http://dx.doi.org/10.1152/ajpheart.00774.2018DOI Listing
April 2019
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