title: Bovine hemoglobin-based oxygen carrier (HBOC-201) for resuscitation of uncontrolled, exsanguinating liver injury in swine. Carolina Resuscitation Research Group.
abstract: In the setting of rapidly exsanguinating hemorrhage, resuscitation with intravenous (i.v.) crystalloid solution may not sustain survival before availability of allogenic blood transfusion and surgery. This study tested the hypothesis that bovine hemoglobin-based oxygen carrier, HBOC-201, would improve resuscitation and extend early survival from exsanguinating hemorrhage. This study simulated the prehospital scenario of rapidly exsanguinating hemorrhage with prolonged prehospital time and lack of blood availability. Severe hemorrhagic shock was induced in swine by using multiple liver lacerations. At 9 min after the onset of bleeding, swine were randomized to receive approximately 10 mL/kg/min of i.v. lactated Ringer's solution (n = 10) or HBOC-201 (n = 7) to achieve a mean aortic pressure (MAP) of 60 mmHg. Thereafter, infusion rate was adjusted to maintain MAP at 60 mmHg for up to 2 h. All animals were initially successfully resuscitated. The results showed 2-h survival was 1 of 10 with lactated Ringer's and 7 of 7 with HBOC-201 (P = 0.0004). Nine lactated Ringer's swine had cardiovascular collapse at 36 +/- 10 min. Lactate at 30 min was 18 +/- 3 mmol/L with lactated Ringer's and 12 +/- 2 mmol/L with HBOC-201 (P < 0.05). Hematocrit was <1% in 9 of 10 lactated Ringer's and 6 of 7 HBOC-201 animals. These data indicate that HBOC-201 improved early survival and stabilized hemodynamic and metabolic parameters vs. lactated Ringer's in this swine model of liver injury with uncontrolled, lethal hemorrhage that simulates the prehospital care environment where allogenic blood is unavailable.
authors.affiliation: Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, 27599-7594, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Manning
authors.forename: L M
authors.initials: LM
authors.lastname: Katz
authors.forename: M R
authors.initials: MR
authors.lastname: Brownstein
authors.forename: L B
authors.initials: LB
authors.lastname: Pearce
authors.forename: M S
authors.initials: MS
authors.lastname: Gawryl
authors.forename: C C
authors.initials: CC
authors.lastname: Baker
mesh_terms: D000818:Animals; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000187:drug effects; D001802:Blood Substitutes / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects*; D006454:Hemoglobins; D006470:Hemorrhage / Q000503:physiopathology / Q000628:therapy*; D007262:Infusions, Intravenous; D007552:Isotonic Solutions / Q000008:administration & dosage; D019344:Lactic Acid / Q000097:blood; D008099:Liver / Q000098:blood supply / Q000293:injuries*; D011897:Random Allocation; D012119:Respiration / Q000187:drug effects; D012151:Resuscitation / Q000379:methods*; D000077331:Ringer's Solution; D015996:Survival Rate; D013552:Swine; D014950:Wounds, Penetrating / Q000503:physiopathology / Q000628:therapy*
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; D007552:Isotonic Solutions; C096798:HBOC 201; D019344:Lactic Acid; D000077331:Ringer's Solution