Trauma is the major cause of mortality in individuals under 45 years of age and accounts for a large percentage of those killed in military combat, with exsanguination being the principal cause of trauma mortality. Life-threatening hemorrhages occur both in profuse bleeding from solid organs, (for example, AAST-OIS grades IV and V complex hepatic injuries), and from bleeding in regions that are difficult to access (particularly the pelvic area). Through our preliminary work, we have demonstrated the potential of High Intensity Focused Ultrasound (HIFU) to induce vascular and organ hemorrhage hemostasis in animal models. Ultrasound also provides a useful and highly-developed imaging modality that is in widespread use in a clinical environment. We propose to utilize both the imaging and therapeutic capabilities of ultrasound to develop a specific device and a methodology for the intraoperative treatment of profuse bleeding, particularly AAST-OIS grades IV and V complex hepatic injuries, which have a high mortality rate, and for severe wounds in the pelvic area. The current clinical approach to severe hepatic injuries is to pack the wounds until hemodynamic stability is achieved, and then to transfer the patient to the angiography suite where angioembolization of the damaged vessels is performed. Valuable time is lost in this transfer because angiography cannot be performed in the operating room. We have considerable preliminary data in animal models that suggests that an image-guided HIFU device could be used to induce hemostasis at the site of the wound, or to occlude the vessels supplying the bleeding site, immediately, and within the confines of the operating room, thus obviating the need for angioembolization, and/or significant operative maneuvers. Our proposal describes four general tasks that need to be accomplished to meet this exciting goal: (1) To utilize ultrasound contrast agents to improve bleeding detection; (2) To develop ultrasound techniques and protocols for detection, localization, and targeting of bleeding sites; (3) To develop an integrated image guided HIFU therapy system; and (4) To perform in vivo experiments on a porcine model to demonstrate the capabilities of image-guided intraoperative acoustic hemostasis. Finally, progress in this area would provide a firm foundation for the ultimate goal of this research-that of a fully automated, portable, image-guided transcutaneous acoustic hemostasis device that could be used by first responders in civilian trauma injuries. ? ? ?

Agency
National Institute of Health (NIH)
Institute
National Institute of General Medical Sciences (NIGMS)
Type
Research Project (R01)
Project #
1R01GM077318-01A1
Application #
7261068
Study Section
Biomedical Imaging Technology Study Section (BMIT)
Program Officer
Somers, Scott D
Project Start
2007-07-01
Project End
2011-04-30
Budget Start
2007-07-01
Budget End
2008-04-30
Support Year
1
Fiscal Year
2007
Total Cost
$378,596
Indirect Cost
Name
University of Washington
Department
Physics
Type
Schools of Earth Sciences/Natur
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
Harper, Jonathan D; Shah, Anup; Mitchell, Stuart B et al. (2012) Novel high-intensity focused ultrasound clamp--potential adjunct for laparoscopic partial nephrectomy. J Endourol 26:1494-9