A hemoglobin based oxygen carrier, bovine polymerized hemoglobin (HBOC-201) versus Hetastarch (HEX) in an uncontrolled liver injury hemorrhagic shock swine model with delayed evacuation.
BACKGROUND
As HBOC-201 improves outcome in animals with hemorrhagic shock (HS), we compared HBOC-201 and HEX (used by U.S. military special operations forces) in a swine model of delayed evacuation and uncontrolled HS.


METHODS
Twenty-four Yucatan pigs underwent a grade III liver injury and were resuscitated with HBOC-201, HEX, or no fluid (NON). Additional infusions were given for hypotension or tachycardia. After 4 hours, the liver was repaired; IV fluids and blood transfusions were administered. Pigs were monitored for 72 hours.


RESULTS
Survival was 7/8, 1/8, and 1/8 in HBOC-201-, HEX-, and NON-resuscitated pigs, respectively. Compared with HEX, HBOC-201 pigs had higher systemic and pulmonary artery pressures and had comparable cardiac outputs, but were less tachycardic. Transcutaneous tissue oxygenation was restored more rapidly in HBOC-201 pigs, there was a trend to lower lactic acid, and base deficit was less. HBOC-201 pigs had lower fluid requirements, higher urine output, and lower blood loss than HEX pigs.


CONCLUSIONS
Despite evidence of vasoactivity, HBOC-201 more effectively stabilized tissue oxygenation, reversed anaerobic metabolism, decreased bleeding, and increased survival in comparison with HEX. If confirmed in clinical trials, these data suggest that for the resuscitation of combat casualties with delayed evacuation and uncontrolled HS due to solid organ injury, HBOC-201 is a superior low-volume resuscitative fluid.
Gurney
Jennifer
J
Walter Reed Army Medical Center (J.G.), Washington, DC, USA.
Philbin
Nora
N
Rice
Jennifer
J
Arnaud
Françoise
F
Dong
Feng
F
Wulster-Radcliffe
Meghan
M
Pearce
L Bruce
LB
Kaplan
Lewis
L
McCarron
Richard
R
Freilich
Daniel
D
D000818:Animals; D001802:Blood Substitutes / Q000494:pharmacology*; D002417:Cattle; D004195:Disease Models, Animal; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007262:Infusions, Intravenous; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D010100:Oxygen / Q000097:blood*; D011336:Probability; D011897:Random Allocation; D012151:Resuscitation / Q000379:methods; D012680:Sensitivity and Specificity; D012771:Shock, Hemorrhagic / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate; D013552:Swine; D014655:Vascular Resistance / Q000187:drug effects
D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; C079129:hemoglobin polymer; D010100:Oxygen