What If I Don’t Have Blood? Hextend is Superior to 3% Saline in an Experimental Model of Far Forward Resuscitation After Hemorrhage

• Published in: Shock (Augusta, Ga.) Ga.), 2016-09, Vol.46 (3S Suppl 1), p.148-153
• Main Authors: Jernigan, Peter L, Hoehn, Richard S, Cox, Daniel, Heyl, Judy, Dorlac, Warren C, Pritts, Timothy A
• Format: Article
• Language: English
• Subjects: Animals; Arterial Pressure; Blood Pressure - physiology; Blood Transfusion; Disease Models, Animal; Female; Fluid Therapy; Hemodynamics - drug effects; Hemorrhage - therapy; Hydroxyethyl Starch Derivatives - therapeutic use; Interleukin-6 - metabolism; Resuscitation - methods; Saline Solution, Hypertonic - therapeutic use; Splenectomy; Swine; Treatment Outcome
• ISSN: 1073-2322; 1540-0514
• DOI: 10.1097/SHK.0000000000000676

INTRODUCTION:Hypertonic crystalloid solutions, colloids, and fresh whole blood (FWB) have all been proposed for prehospital resuscitation after hemorrhage. However, there are no direct comparisons of the efficacy of these different fluids. We compared Hextend, 3% hypertonic saline (HS), and FWB in a porcine model of hemorrhagic shock. MATERIALS AND METHODS:Female swine (n = 5/group) underwent splenectomy and pressure-controlled hemorrhage followed by resuscitation with Hextend, 3% HS, or FWB. They were maintained at a target mean arterial pressure (MAP) for 4 h, holding or infusing fluid as necessary. Sham animals for comparison underwent splenectomy alone. RESULTS:The mean volume required to maintain target MAP was significantly higher for 3% HS (1,016 ± 386 mL) than for Hextend (346 ± 299 mL, P