Engineering Low Volume Resuscitants for the Prehospital Care of Severe Hemorrhagic Shock

Globally, traumatic injury is a leading cause of suffering and death. The ability to curtail damage and ensure survival after major injury requires a time-sensitive response balancing organ perfusion, blood loss, and portability, underscoring the need for novel therapies for the prehospital environm...

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Bibliographic Details
Published in:Angewandte Chemie International Edition 2024-07, Vol.63 (31), p.e202402078
Main Authors: Pichon, Trey J, Wang, Xu, Mickelson, Ethan E, Huang, Wen-Chia, Hilburg, Shayna L, Stucky, Sarah, Ling, Melissa, S John, Alexander E, Ringgold, Kristyn M, Snyder, Jessica M, Pozzo, Lilo D, Lu, Maggie, White, Nathan J, Pun, Suzie H
Format: Article
Language:English
Subjects:
Addition polymerization
Animals
Blood
Blood coagulation
Blood pressure
Blood volume
Chemical composition
Coagulation
Colloid chemistry
Damage
Disease Models, Animal
Emergency Medical Services
Hemorrhage
Hemorrhagic shock
Polymers
Polymers - chemistry
Portability
Rats
Resuscitation
Resuscitation - methods
Shock, Hemorrhagic - therapy
Trauma
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Summary:Globally, traumatic injury is a leading cause of suffering and death. The ability to curtail damage and ensure survival after major injury requires a time-sensitive response balancing organ perfusion, blood loss, and portability, underscoring the need for novel therapies for the prehospital environment. Currently, there are few options available for damage control resuscitation (DCR) of trauma victims. We hypothesize that synthetic polymers, which are tunable, portable, and stable under austere conditions, can be developed as effective injectable therapies for trauma medicine. In this work, we design injectable polymers for use as low volume resuscitants (LVRs). Using RAFT polymerization, we evaluate the effect of polymer size, architecture, and chemical composition upon both blood coagulation and resuscitation in a rat hemorrhagic shock model. Our therapy is evaluated against a clinically used colloid resuscitant, Hextend. We demonstrate that a radiant star poly(glycerol monomethacrylate) polymer did not interfere with coagulation while successfully correcting metabolic deficit and resuscitating animals from hemorrhagic shock to the desired mean arterial pressure range for DCR - correcting a 60 % total blood volume (TBV) loss when given at only 10 % TBV. This highly portable and non-coagulopathic resuscitant has profound potential for application in trauma medicine.
ISSN:1433-7851
1521-3773
1521-3773
DOI:10.1002/anie.202402078