Diaspirin cross-linked hemoglobin resuscitation of hemorrhage: comparison of a blood substitute with hypertonic saline and isotonic saline.
Resuscitation with tiny volumes of hypertonic solutions rapidly restores tissue perfusion while minimizing edema after hemorrhage and tissue trauma.


METHODS
We compared an O2-carrying fluid, Diaspirin Cross-Linked Hemoglobin (DCLHb), to 7.5% NS/Dextran-70 (HTS) or 0.9% saline (NS) in a trauma (celiotomy) hemorrhage model. Anesthetized rats (n = 10/group) underwent a tracheotomy, placement of jugular vein and carotid artery catheters, and placement of an abdominal aortic flow probe. Rats were hemorrhaged (20 mL/kg) from t = 0-15 minutes, and were given NS (group I), 60 mL/kg, HTS (group II), 4 mL/kg, or DCLHb (group III), 4 mL/kg, from t = 15-30 minutes. Sampling mandated removal of an additional 10 mL/kg of blood during the 2-hour experiment.


RESULTS
Mean arterial pressure was restored after hemorrhage in all groups. Oxygen delivery, which diminished dramatically after hemorrhage, was less than baseline in all groups after resuscitation. Oxygen consumption was restored in all groups after a sharp decrease during hemorrhage. Base deficit increased in the all groups but was greatest after normal saline or hypertonic saline resuscitation (t = 120 minutes; I = 12 +/- 0.4*, II = 13 +/- 0.5* c, III = 10 +/- 0.1*; * = p < 0.05 versus baseline value within group for groups I, II, and III; c = p < 0.05 group versus DCLHb (group II), by ANOVA).


CONCLUSIONS
DCLHb restored mean arterial pressure and ameliorated the development of flow-dependent oxygen consumption. Base deficit, a reflection of systemic oxygen debt, was minimized with this blood substitute. DCLHb may represent a superior small volume resuscitative fluid after trauma and hemorrhage.
Cohn
S M
SM
Section of Trauma and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut.
Farrell
T J
TJ
D000818:Animals; D001241:Aspirin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006439:Hemodynamics; D006454:Hemoglobins / Q000627:therapeutic use*; D006470:Hemorrhage / Q000628:therapy*; D007552:Isotonic Solutions; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012965:Sodium Chloride / Q000627:therapeutic use*
D006454:Hemoglobins; D007552:Isotonic Solutions; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin