Controlled resuscitation for uncontrolled hemorrhagic shock.
OBJECTIVE
To test the hypothesis that controlled resuscitation can lead to improved survival in otherwise fatal uncontrolled hemorrhage.


METHODS
Uncontrolled hemorrhage was induced in 86 rats with a 25-gauge needle puncture to the infrarenal aorta. Resuscitation 5 minutes after injury was continued for 2 hours with lactated Ringer's solution (LR), 7.3% hypertonic saline in 6% hetastarch (HH), or no fluid (NF). Fluids infused at 2 mL x kg(-1) x min(-1) were turned on or off to maintain a mean arterial pressure (MAP) of 40, 80, or 100 mm Hg in six groups: NF, LR 40, LR 80, LR 100, HH 40, and HH 80. Blood loss was measured before and after 1 hour of resuscitation.


RESULTS
Survival was improved with fluids. Preresuscitation blood loss was similar in all groups. NF rats did not survive 4 hours. After 72 hours, LR 80 rats (80%) and HH 40 rats (67%) showed improved survival over NF rats (0%) (p < 0.05). Rebleeding increased with MAP. Attempts to restore normal MAP (LR 100) led to increased blood loss and mortality.


CONCLUSIONS
Controlled resuscitation leads to increased survival compared with no fluids or standard resuscitation. Fluid type affects results. Controlled fluid use should be considered when surgical care is not readily available.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814-4799, USA. dburris@usuhs.mil
D
D
Burris
P
P
Rhee
C
C
Kaufmann
E
E
Pikoulis
B
B
Austin
A
A
Eror
S
S
DeBraux
L
L
Guzzi
A
A
Leppäniemi
D000818:Animals; D001011:Aorta / Q000293:injuries; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods*; D006400:Hematocrit; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D000077331:Ringer's Solution; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012964:Sodium / Q000097:blood; D016019:Survival Analysis; D013997:Time Factors
D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D019344:Lactic Acid; D000077331:Ringer's Solution; D012964:Sodium