A cadaveric Thiel-embalmed human model for the study of the cavo-pulmonary venous return
CCCF ePoster library. Morency-Lemieux M. Nov 2, 2016; 150980
Maude Morency-Lemieux
Maude Morency-Lemieux
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Topic: Basic or Translational Science

A cadaveric Thiel-embalmed human model for the study of the cavo-pulmonary venous return


Morency-Lemieux Maude1, Alexandre Desaulniers1, Gilles Bronchti 2, Karim Serri1,3, Emmanuel Charbonney1, 2,3 and Detlev Grabs2

1 Faculté de Médecine, Université de Montréal, Montréal, Canada; 2 Département d'anatomie, Université du Québec à Trois-Rivières (UQTR), Trois-Rivières, Canada; 3 Département de soins intensifs, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada


Grant acknowledgements:
Maude Morency-Lemieux was supported by the summer excellence bursary from the Anatomy Department (UQTR)

Abstract:

Introduction
After cardiac arrest, the major determinant of optimal brain and coronary perfusion is the arterio-venous pressure gradient. During cardio-pulmonary resuscitation (CPR), the applied manoeuvre will provoke variation of the intra-thoracic pressure (ITP) and determine blood flow, in part by impacting on venous return. In an animal model of closed CPR, venous return during CPR was shown to be dependent on inferior vena cava (IVC) pressure. Interaction between the ITP variations and IVC pressure during different strategies of CPR needs to be determined in humans.
Fresh human cadaveric or alternatively Thiel embalmed body flow models for surgical or endovascular interventional techniques have been recently developed. The Thiel embalming method allows cadavers to retain elastic and dynamic properties with tissue textures and microvasculature close to living patients. Thiel-embalmed pig lung vasculature perfusion has been tested but it has not been done in human bodies.
 
Objectives
1) To develop a model of cadaveric venous return in order to study the effect of ITP on the vena cava pressure variation. 2) To establish an artificial circulatory flow through the lung vasculature in the Thiel embalmed human cadavers.
 
Methods
The experiments were conducted at the UQTR anatomy laboratory in accordance with Canadian regulation, after ethics committee approval. Parts of experiments were done with the lung-heart block ex-situs. Embalmed bodies were prepared by clamping both jugular veins and one femoral vein. In the first set of experiments, in order to opacify the venous and pulmonary vasculature, a 14Fr urinary catheter was introduced through the femoral vein up to the lower IVC and iodixanol (Visipaque™), a radiopaque liquid, was injected through. In the second set of experiments, in order to measure pressure variation in the IVC, a balloon-tipped catheter was placed in the IVC, through the urinary catheter which was placed in the iliac vein with its extremity at the origin of the IVC (Fig 1). Radiology images were used to verify catheters placements (i.e urinary catheter balloon filled with barium) and document successful opacifications. A Stryker monitor® was connected to the balloon-tipped catheter, filled with water, to measure the intravenous pressure. Vegetal oil was used for vascular flushing with a Masterflex peristaltic pump®
 
Results
The injection of iodixanol contrast solution in the pulmonary trunk allowed complete opacification of the arterial tree of the lungs ex-situ (Fig 2A) and similar images could be obtained when a different radiopaque fluid was injected through the femoral vein in the intact bodies (Fig 2B). A transpulmonary circulation could be established ex-situ, while flushing oil through the pulmonary trunk and observing oil flowing from the pulmonary veins into the left atrium (video).
Finally, while flushing 500 mL of oil through the left femoral vein (cf Fig 1) at a rate of  60 ml/min  and applying chest compressions, a pressure fluctuation was observed and measured by the IVC balloon-catheter.

Conclusion
In human Thiel cadavers, the cavo-pulmonary system is patent, as well as the arterial lung vasculature; a transpulmonary circulation can be set. We established a preliminary model to measure pressure variation in the IVC, while providing venous return flow and applying chest compressions. Further development and calibration need to be done in order to test this experimental model.
 


References:

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Anders AB et al. JAMA 1984; 252:3283-3286
Redberg RF et al. Circulation 1993; 88:534–42. 
Takata M et al. J Appl Physiol 1990. 69(6): 1961-72.
James T Niemann et al. Ann Emerg Med. 1990;19(11):1232-7
Willaert W et al. Eur Surg Res. 2014;52(1-2):8-20



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