Use of hypertonic saline/dextran versus lactated Ringer's solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine.
OBJECTIVE
We tested the hypothesis that following aortotomy, administration of hypertonic saline/dextran increases hemorrhage and mortality. We also compared hypertonic saline/dextran with the standard therapy of attempting to replace three times the amount of lost blood with lactated Ringer's solution.


METHODS
In this model of uncontrolled arterial hemorrhage resulting from aortotomy, 24 anesthetized Yorkshire swine underwent splenectomy, stainless steel wire placement in the infrarenal aorta, and instrumentation with Swan-Ganz and carotid artery catheters. The wire was pulled, producing a 5-mm aortotomy and spontaneous intraperitoneal hemorrhage.


METHODS
The animals were randomly assigned to one of three study groups: control; hypertonic saline/dextran group in which six minutes after aortotomy a 4-mL/kg mixture of IV 7.5% NaCl and 6% Dextran-70 was given over one minute; or lactated Ringer's group in which six minutes after aortotomy 80 mL/kg IV lactated Ringer's was given over nine minutes.


RESULTS
The volume of hemorrhage and the mortality rate in hypertonic saline/dextran-treated animals were significantly greater than in the nonresuscitated controls (1,340 +/- 230 mL versus 783 +/- 85 mL and five of eight versus zero of eight, respectively; P less than .05). Although the mortality rate in the lactated Ringer's group was not significantly different from the hypertonic saline/dextran group, survival time was significantly shorter than in the hypertonic saline/dextran group.


CONCLUSIONS
In this model of uncontrolled hemorrhage, immediate IV administration of hypertonic saline/dextran significantly increased hemorrhage volume and mortality. However, the accentuation of hemorrhage and reduction in survival were not as great as that produced by the standard practice of attempting to replace the lost blood with three times that volume of lactated Ringer's.
Bickell
W H
WH
Division of Military Trauma Research, Letterman Army Institute of Research, Presidio of San Francisco, California.
Bruttig
S P
SP
Millnamow
G A
GA
O'Benar
J
J
Wade
C E
CE
D000758:Anesthesia; D000818:Animals; D001012:Aorta, Abdominal; D001018:Aortic Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D016063:Blood Loss, Surgical / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003911:Dextrans / Q000009:adverse effects* / Q000627:therapeutic use; D006400:Hematocrit; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D007552:Isotonic Solutions / Q000009:adverse effects* / Q000627:therapeutic use; D010101:Oxygen Consumption; D011897:Random Allocation; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic; D015996:Survival Rate; D013552:Swine
D003911:Dextrans; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012462:Saline Solution, Hypertonic