Resuscitation with whole blood or blood components improves survival and lessens the pathophysiological burden of trauma and haemorrhagic shock in a pre-clinical porcine model

Purpose In military trauma, disaster medicine, and casualties injured in remote locations, times to advanced medical and surgical treatment are often prolonged, potentially reducing survival and increasing morbidity. Since resuscitation with blood/blood components improves survival over short pre-su...

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Bibliographic Details
Published in:European journal of trauma and emergency surgery (Munich : 2007) 2023-02, Vol.49 (1), p.227-239
Main Authors: Watts, Sarah Ann, Smith, Jason Edward, Woolley, Thomas, Rickard, Rory Frederick, Gwyther, Robert, Kirkman, Emrys
Format: Article
Language:English
Subjects:
Animals
Blood
Blood Component Transfusion
Blood transfusions
Critical Care Medicine
Emergency medical care
Emergency Medicine
Fluid Therapy
Hemorrhage - therapy
Hemorrhagic shock
Intensive
Liver - injuries
Medicine
Medicine & Public Health
Original
Original Article
Pathophysiology
Resuscitation - methods
Shock, Hemorrhagic - drug therapy
Sports Medicine
Surgery
Surgical Orthopedics
Swine
Trauma
Traumatic Surgery
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Summary:Purpose In military trauma, disaster medicine, and casualties injured in remote locations, times to advanced medical and surgical treatment are often prolonged, potentially reducing survival and increasing morbidity. Since resuscitation with blood/blood components improves survival over short pre-surgical times, this study aimed to evaluate the quality of resuscitation afforded by blood/blood products or crystalloid resuscitation over extended ‘pre-hospital’ timelines in a porcine model of militarily relevant traumatic haemorrhagic shock. Methods This study underwent local ethical review and was done under the authority of Animals (Scientific Procedures) Act 1986. Forty-five terminally anaesthetised pigs received a soft tissue injury to the right thigh, haemorrhage (30% blood volume and a Grade IV liver injury) and fluid resuscitation initiated 30 min later [Group 1 (no fluid); 2 (0.9% saline); 3 (1:1 packed red blood cells:plasma); 4 (fresh whole blood); or 5 (plasma)]. Fluid (3 ml/kg bolus) was administered during the resuscitation period (maximum duration 450 min) when the systolic blood pressure fell below 80 mmHg. Surviving animals were culled with an overdose of anaesthetic. Results Survival time was significantly shorter for Group 1 compared to the other groups ( P  
ISSN:1863-9933
1863-9941
DOI:10.1007/s00068-022-02050-6