Systemic and microcirculatory effects of autologous whole blood resuscitation in severe hemorrhagic shock

• Published in: American journal of physiology. Heart and circulatory physiology 1999-06, Vol.276 (6), p.H2035-H2043
• Main Authors: Kerger, Heinz, Waschke, Klaus F, Ackern, Klaus V, Tsai, Amy G, Intaglietta, Marcos
• Format: Article
• Language: English
• ISSN: 0363-6135; 1522-1539
• DOI: 10.1152/ajpheart.1999.276.6.H2035

1  Department of Anesthesiology and Operative Critical Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, D-68135 Mannheim, Germany; and 2  Department of Bioengineering, University of California San Diego, La Jolla, California 92093 Systemic and microcirculatory effects of autologous whole blood resuscitation after 4-h hemorrhagic shock with a mean arterial pressure (MAP) level of 40 mmHg were investigated in 63 conscious Syrian golden hamsters. Microcirculation of skeletal skin muscle and subcutaneous connective tissue was visualized in a dorsal skinfold. Shed blood was retransfused within 30 min after 4 h. Animals were grouped into survivors in good (SG) and poor condition (SP) and nonsurvivors (NS) according to 24-h outcome after resuscitation and studied before shock, during shock (60, 120, and 240 min), and 30 min and 24 h after resuscitation. Microvascular and interstitial P O 2 values were determined by phosphorescence decay. Shock caused a significant increase of arterial P O 2 and decrease of P CO 2 , pH, and base excess. In the microcirculation, there was a significant decrease in blood flow ( B ), functional capillary density (FCD; capillaries with red blood cell flow), and interstitial P O 2 [1.8 ± 0.8 mmHg (SG), 1.3 ± 1.3   mmHg (SP), and 0.9 ± 1.1 mmHg (NS) vs. 23.0 ± 6.1 mmHg at control]. Blood resuscitation caused immediate MAP recompensation in all animals, whereas metabolic acidosis, hyperventilation, and a significant interstitial P O 2 decrease (40-60% of control) persisted. In NS (44.4% of the animals), systemic and microcirculatory alterations were significantly more severe both in shock and after resuscitation than in survivors. Whereas in SG (31.8% of the animals) there was only a slight (15-30%) but still significant impairment of microscopic tissue perfusion ( B , FCD) and oxygenation at 24   h, SP (23.8% of the animals) showed severe metabolic acidosis and substantial decreases ( 50%) of FCD and interstitial P O 2 . FCD, interstitial P O 2 , and metabolic state were the main determinants of shock outcome. microcirculation; autologous blood; partial pressure of oxygen; functional capillary density; base excess; phosphorescence decay