title: A comparison of the response of near-fatal acute hemorrhage models with and without a vascular injury to rapid volume expansion.
abstract: Recent studies in which animals were bled from a vascular injury rather than an intravascular catheter demonstrate increased blood loss and mortality with rapid volume expansion. The purpose of this study was to better define the importance of incorporating a vascular injury in animal models of acute hemorrhage. We directly compared the response to resuscitation from hemorrhage of comparable severity in animals with and without a vascular injury. Thirty-four immature swine (14.6 to 23.2 kg) were instrumented and subjected to severe blood loss (40 to 46 mL/kg). Groups I and II were hemorrhaged from a femoral artery catheter only. Groups III and IV were initially bled in the same manner; however, when the mean arterial pressure (MAP) decreased to 30 mm Hg, a 4-mm tear was created in the infrarenal aorta, allowing free intraperitoneal hemorrhage. In all groups, the catheter hemorrhage was discontinued once the pulse pressure reached 5 mm Hg. Groups II and IV were resuscitated with normal saline (NS) infused at a rate of 6 mL/kg/min followed by shed blood at a rate of 2 mL/kg/min. The resuscitation fluids were infused as needed to maintain a MAP of 80 mm Hg. Groups I and III served as controls and were not resuscitated. All animals were observed for 60 minutes or until death. The data were compared using repeated measures analysis of variance with a post hoc Tukey Kramer and the Fisher's exact test. Mortality was 100%, 0%, 88%, and 78% for groups I, II, III, and IV, respectively (P < .05 for group II vs groups I, III, and IV).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, OH.
authors.forename: S C
authors.initials: SC
authors.lastname: Dronen
authors.forename: S A
authors.initials: SA
authors.lastname: Stern
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: M
authors.initials: M
authors.lastname: Stanley
mesh_terms: D000208:Acute Disease; D000818:Animals; D001011:Aorta / Q000293:injuries; D001794:Blood Pressure; D002302:Cardiac Output; D005440:Fluid Therapy / Q000379:methods; D006400:Hematocrit; D006470:Hemorrhage / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008955:Models, Cardiovascular; D010100:Oxygen / Q000097:blood; D011897:Random Allocation; D013552:Swine
chemical_list: D010100:Oxygen