Low-volume resuscitation cocktail extends survival after severe hemorrhagic shock

• Published in: Shock (Augusta, Ga.) Ga.), 2007-07, Vol.28 (1), p.45-52
• Main Authors: Reynolds, Penny S, Barbee, R Wayne, Skaflen, Marcus D, Ward, Kevin R
• Format: Article
• Language: English
• Subjects: Animals; Blood Pressure; Blood Substitutes - administration & dosage; Cattle; Cross-Linking Reagents; Disease Models, Animal; Hemoglobins - administration & dosage; Hemoglobins - chemistry; Humans; Male; Rats; Rats, Long-Evans; Resuscitation - methods; Saline Solution, Hypertonic - administration & dosage; Shock, Hemorrhagic - physiopathology; Shock, Hemorrhagic - therapy; Time Factors
• ISSN: 1073-2322
• DOI: 10.1097/shk.0b013e31802eb779

After severe hemorrhage, low-volume resuscitation with hypertonic fluids is increasingly preferred to more aggressive resuscitation strategies. Oxygen delivery to the tissues may be improved by augmentation with hemoglobin [Hb]-based oxygen-carrying compounds (HBOCs); however, previous studies have reported negative outcomes presumably related to extravasation of tetrameric Hb. The purpose of this study was to evaluate a novel large molecular weight polymer of cross-linked bovine Hb (OxyVita; OXYVITA Inc, New Windsor, NY) in a cocktail of hypertonic saline and Hextend (HX; HBOC-C) as an alternative to standard small-volume resuscitation using Hextend (HX) only. Outcomes were survival to 3 h and duration of MAP support more than 60 mmHg without additional fluid support. Conscious male Long-Evans rats were hemorrhaged to 60% total blood volume over 40 min. There were 4 groups: HBOC-C administered in a pressure-titrated infusion, HX titration, HBOC-C administered as a bolus, and HX bolus. Cardiovascular parameters, arterial gases, acid-base status, metabolites, electrolytes, Hb level, and oxygen saturation were measured at baseline, during each 20% hemorrhage increment, and 1, 2, and 3 h after the initiation of hemorrhage. Small-volume resuscitation with HBOC-C significantly improved survival to 3 h and improved MAP support times regardless of method of administration. However, physiological status at the end of hemorrhage significantly influenced survival regardless of resuscitation treatment. These results suggest that HBOC-augmented hypertonic cocktails are of promise in improving survival and providing target MAP support during small-volume resuscitation. Experimental evaluation of any resuscitation therapy should account for the degree of preexisting physiological compromise before therapy is initiated.