title: Resuscitation from hemorrhagic shock with diaspirin cross-linked hemoglobin, blood, or hetastarch.
abstract: BACKGROUND
  An oxygen-transporting hemoglobin solution should be more effective than a nonhemoglobin solution for resuscitation from hemorrhagic shock. A way to evaluate this effectiveness is to determine whether a hemoglobin solution can reverse the base deficit accumulated during hemorrhage at a faster rate than a nonhemoglobin solution. Using this criterion, we compared the resuscitative powers of autologous blood, hetastarch (Het), and diaspirin cross-linked hemoglobin (DCLHb).
  
  
  METHODS
  Fifteen sedated, spontaneously breathing sheep (37.5 +/- 10.2 kg) were bled until base deficits fell to -5 to -10 mEq/L, and plasma lactate concentrations rose to 6 to 9 mg/L. The animals were resuscitated with autologous blood (n = 5), Het (n = 5), or DCLHb (n = 5) (3.5-4.0 mL/kg every 15 minutes) until base deficits returned to prehemorrhage baseline.
  
  
  RESULTS
  Exsanguination to target base deficits required removal of an average of 41.4 +/- 5.5 mL blood/kg (estimated total blood volume, 80 mL/kg). Resuscitation required 18 +/- 3, 38 +/- 2 (different from blood), and 35 +/- 1 (different from blood) mL/kg of autologous blood, Het and DCLHb, respectively, over periods of 78 +/- 8, 163 +/- 10 (different from blood), and 129 +/- 9 minutes (different from blood and different from Het (p < or = 0.05)). Based on regression analysis, autologous blood, Het, and DCLHb corrected the base deficit at rates of, respectively, 0.074 (different from Het (p < or = 0.05)), 0.016, and 0.056 (different from Het (P < or = 0.05)) mEq/L/min.
  
  
  CONCLUSIONS
  Based on the rate of base deficit correction and the volume of solution required, autologous blood was the most effective resuscitation solution. However, DCLHb was more effective than Het. DCLHb may be an attractive alternative to blood for resuscitation from hemorrhagic shock.
authors.affiliation: Department of Surgery, University of Wisconsin-Madison Medical School, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: DeAngeles
authors.forename: A M
authors.initials: AM
authors.lastname: Scott
authors.forename: A M
authors.initials: AM
authors.lastname: McGrath
authors.forename: V A
authors.initials: VA
authors.lastname: Korent
authors.forename: L A
authors.initials: LA
authors.lastname: Rodenkirch
authors.forename: R L
authors.initials: RL
authors.lastname: Conhaim
authors.forename: B A
authors.initials: BA
authors.lastname: Harms
mesh_terms: D000818:Animals; D001241:Aspirin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001784:Blood Gas Analysis; D001802:Blood Substitutes / Q000627:therapeutic use*; D001804:Blood Transfusion, Autologous; D006439:Hemodynamics; D006454:Hemoglobins / Q000032:analysis / Q000627:therapeutic use*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007773:Lactates / Q000097:blood; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010952:Plasma Substitutes / Q000627:therapeutic use*; D012044:Regression Analysis; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D007773:Lactates; D010952:Plasma Substitutes; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin; D010100:Oxygen