The benefits of 7.5% NaCl/6% dextran 70 (HSD) for prehospital resuscitation of hemorrhagic shock: improved oxygen transport.
The purpose of this study was to compare the benefit of small volume hypertonic saline/dextran (HSD) versus the risk of obligatory time to administer it on-scene in a model of acute hemorrhagic shock. Dogs were bled to a mean arterial pressure (MAP) of 20 mmHg and then randomized to either: a) direct transport to the emergency department (ED) or b) 10 min delay to insert an iv HSD (4 ml/kg) infusion over 5 min, and then transport. The animals receiving HSD had improved (P less than 0.05) cardiac work and oxygen consumption during transport (MAP = 59 +/- 3 vs 38 +/- 4 mmHg; cardiac index (CI) = 3.2 +/- 0.2 vs 1.3 +/- 0.1 L min-1 M-2; O2CI = 115 +/- 7 vs 104 +/- 7 ml min-1 M-2), paralleled by reduced serum lactate (5.3 +/- 0.8 vs 7.0 +/- 2.3 mmol/L) and decreased metabolic acidosis. The benefits of HSD in attenuating shock-induced oxygen debt were corroborated by lower O2CI (98 +/- 4 vs 112 +/- 5 ml min-1 M-2) and higher pH (7.30 +/- 0.01 vs 7.24 +/- 0.02) in the postresuscitation period.
Siritongtaworn
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P
Department of Surgery, Denver General Hospital, CO 80204.
Moore
E E
EE
Marx
J A
JA
Van Lighten
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P
Ammons
L A
LA
Bar-Or
D
D
D000818:Animals; D004195:Disease Models, Animal; D004285:Dogs; D004632:Emergency Medical Services; D005440:Fluid Therapy; D006801:Humans; D010101:Oxygen Consumption; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients