Fatal myocardial depression and circulatory collapse associated with complement activation induced by plasma infusion in severe porcine sepsis.
We have previously reported that fresh frozen plasma (FFP) may induce a rapid irreversible shock when repeatedly infused in pigs challenged with Gram-negative sepsis. The aims of the present study were to elucidate the cardiovascular nature of the shock and determine the aetiologic role of tumour necrosis factor (TNF), complement activation and halothane anaesthesia. Three groups of anaesthetized piglets were inoculated with a lethal dose of live E. coli bacteria. Groups I (n = 8) and III (n = 8) were anaesthetized with halothane and group II (n = 8) with ketamine. Animals in groups I and II received repeated infusions of FFP, whereas animals in group III received repeated infusions of 7% albumin. Six animals in group I and four animals in group II died during the first plasma infusion. Survival time was significantly longer in group II (P = 0.04) compared to group I. No animals in group III died during the albumin infusions, and no adverse effects were observed during the infusions. In group I the plasma induced shock was characterized by abruptly falling mean arterial pressure, cardiac index, systemic vascular resistance index and left ventricular contractility. Concomitant increases were recorded in left ventricular filling pressure and central venous pressure. Group II demonstrated a similar, but delayed response. Plasma infusion was associated with a significant increase in terminal complement complex (TCC) (P < 0.03 in group I, P < 0.05 in group II) and depletion of serum ionized calcium. We conclude that FFP may induce fatal myocardial depression and circulatory collapse in severe sepsis. Complement activation may be of aetiologic importance.
Busund
R
R
Department of Surgery, Tromsø University Hospital, Norway.
Balteskard
L
L
Rønning
G
G
Høgåsen
K
K
Revhaug
A
A
D000418:Albumins / Q000008:administration & dosage / Q000494:pharmacology; D000769:Anesthesia, Inhalation; D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D002118:Calcium / Q000097:blood; D002302:Cardiac Output / Q000502:physiology; D002496:Central Venous Pressure / Q000502:physiology; D003167:Complement Activation / Q000276:immunology*; D004927:Escherichia coli Infections / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D006221:Halothane / Q000494:pharmacology; D006323:Heart Arrest / Q000209:etiology* / Q000276:immunology; D007262:Infusions, Intravenous; D007649:Ketamine / Q000494:pharmacology; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology; D010949:Plasma; D012769:Shock / Q000209:etiology* / Q000276:immunology; D013552:Swine; D014409:Tumor Necrosis Factor-alpha / Q000502:physiology; D014655:Vascular Resistance / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology; D017725:Ventricular Pressure / Q000502:physiology
D000418:Albumins; D014409:Tumor Necrosis Factor-alpha; D007649:Ketamine; D002118:Calcium; D006221:Halothane