Diaspirin cross-linked hemoglobin resuscitation improves cerebral perfusion after head injury and shock.
BACKGROUND
Shock associated with traumatic brain injury (TBI) doubles the mortality of TBI alone by inducing a secondary ischemic injury. Rapid correction of cerebral perfusion pressure (CPP) is thought to be essential to improving outcome. Diaspirin cross-linked hemoglobin (DCLHb) has been shown to improve cerebral blood flow, increase mean arterial pressure (MAP), and reduce lesion size in models of occlusive cerebral ischemia but has not been evaluated in a model of TBI combined with hemorrhagic shock.


METHODS
We studied the effects of DCLHb resuscitation in a porcine model of cryogenic TBI and hemorrhagic shock (MAP = 50 mmHg). After combined insults, animals were randomized to receive a bolus of 4 mliters/kg of either lactated Ringer's solution (n = 5) or DCLHb (n = 6). Lactated Ringer's solution was then infused in both groups to maintain MAP at baseline. Shed blood was returned 1 hour after the initiation of resuscitation (R1). Animals were studied for 24 hours.


RESULTS
DCLHb infusion resulted in a significantly greater MAP at R1 and R24 (95 +/- 4 vs. 82 +/- 2 and 99 +/- 3 vs. 85 +/- 3 mm Hg, respectively) and a significantly greater CPP at R1 and R24 (83 +/- 10 vs. 68 +/- 5 and 89 +/- 6 vs. 71 +/- 11 mm Hg, respectively). Intracranial pressure was lower in the DCLHb group, but this difference was not significant. There was no significant difference between the groups in cerebral oxygen delivery. DCLHb animals required less fluid to maintain MAP (12,094 +/- 552 vs. 15,542 +/- 1094 mliters, p < 0.05).


CONCLUSIONS
These data suggest that DCLHb is beneficial in the early resuscitation of head injury and shock and that further investigation is warranted. Key Words: Diaspirin cross-linked hemoglobin, Head injury, Shock, Cerebral perfusion pressure.
Department of Surgery, University of Vermont, Burlington 05401, USA.
J E
JE
Chappell
W J
WJ
McBride
S R
SR
Shackford
D000818:Animals; D001241:Aspirin / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D001930:Brain Injuries / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D006454:Hemoglobins / Q000494:pharmacology* / Q000627:therapeutic use; D007427:Intracranial Pressure / Q000187:drug effects; D008954:Models, Biological; D010100:Oxygen / Q000097:blood; D012151:Resuscitation / Q000379:methods*; D012769:Shock / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D013552:Swine; D013556:Swine, Miniature; D014655:Vascular Resistance / Q000187:drug effects
D006454:Hemoglobins; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin; D010100:Oxygen