Comparison of standard and alternative prehospital resuscitation in uncontrolled hemorrhagic shock and head injury.
BACKGROUND
Recently acquired data suggest that prehospital fluid resuscitation may worsen outcome of patients with penetrating torso trauma. In patients with head injury, delayed resuscitation (DR) could lead to secondary cerebral ischemia. We hypothesized that standard prehospital resuscitation (SPR) with lactated Ringer's solution or diaspirin cross-linked hemoglobin would reduce secondary cerebral ischemia compared with DR.


METHODS
Anesthetized swine were randomized to receive SPR, diaspirin cross-linked hemoglobin, or DR after cryogenic brain injury and uncontrolled hemorrhagic shock and studied for 70 minutes after the combined insults.


RESULTS
Hemorrhage volume was lowest in the DR group (p<0.05). There were no significant differences between the groups in systemic or cerebral oxygen delivery. Intracranial pressure was lower and cerebral perfusion pressure higher in the diaspirin cross-linked hemoglobin group compared with SPR (p<0.05). Lesion size was greatest in the SPR group, but the difference was not significant.


CONCLUSIONS
In this model, SPR leads to secondary cerebral ischemia. DR is no worse and may be superior to conventional prehospital resuscitation with lactated Ringer's solution.
Novak
L
L
Medical Center Hospital - Vermont, Burlington, USA.
Shackford
S R
SR
Bourguignon
P
P
Nichols
P
P
Buckingham
S
S
Osler
T
T
Sartorelli
K
K
D000818:Animals; D001241:Aspirin / Q000008:administration & dosage / Q000031:analogs & derivatives; D001802:Blood Substitutes / Q000008:administration & dosage; D001930:Brain Injuries / Q000503:physiopathology / Q000628:therapy*; D002545:Brain Ischemia / Q000503:physiopathology / Q000517:prevention & control; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006454:Hemoglobins / Q000008:administration & dosage; D007427:Intracranial Pressure / Q000187:drug effects / Q000502:physiology; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D010100:Oxygen / Q000097:blood; D012151:Resuscitation / Q000379:methods*; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy; D013552:Swine; D013997:Time Factors
D001802:Blood Substitutes; D006454:Hemoglobins; D007552:Isotonic Solutions; D000077325:Ringer's Lactate; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin; D010100:Oxygen