Fluid resuscitation from severe hemorrhagic shock using diaspirin cross-linked hemoglobin fails to improve pancreatic and renal perfusion.
BACKGROUND
Fluid resuscitation from hemorrhagic shock is intended to abolish microcirculatory disorders and to restore adequate tissue oxygenation. Diaspirin cross-linked hemoglobin (DCLHb) is a hemoglobin-based oxygen carrier (HBOC) with vasoconstrictive properties. Therefore, fluid resuscitation from severe hemorrhagic shock using DCLHb was expected to improve perfusion pressure and tissue perfusion of kidneys and pancreas.


METHODS
In 20 anesthetized domestic pigs with an experimentally induced coronary stenosis, shock (mean arterial pressure 45 mmHg) was induced by controlled withdrawal of blood and maintained for 60 min. Fluid resuscitation (replacement of the plasma volume withdrawn during hemorrhage) was performed with either 10% DCLHb (DCLHb group, n = 10) or 8% human serum albumin (HSA) oncotically matched to DCLHb (HSA group, n = 10). Completion of resuscitation was followed by a 60-min observation period. Regional blood flow to the kidneys and the pancreas was measured by use of the radioactive microspheres method at baseline, after shock and 60 min after fluid resuscitation.


RESULTS
All animals (10/10) resuscitated with DCLHb survived the 60-min observation period, while 5/10 control animals died within 20 min due to persisting subendocardial ischemia. In contrast to HSA survivors, pancreas and kidneys of DCLHb-treated animals revealed lower total and regional organ perfusion and regional oxygen delivery. Renal and pancreatic blood flow heterogeneity was higher in the DCLHb group.


CONCLUSIONS
DCLHb-induced vasoconstriction afforded superior myocardial perfusion, but impaired regional perfusion of the kidneys and the pancreas.
Pape
A
A
Clinic of Anaesthesiology, Intensive Care and Pain Management, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. a.pape@em.uni-frankfurt.de
Kleen
M
M
Kemming
G
G
Meisner
F
F
Meier
J
J
Habler
O
O
D000465:Algorithms; D000818:Animals; D001241:Aspirin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D001802:Blood Substitutes / Q000627:therapeutic use*; D005260:Female; D005440:Fluid Therapy; D006454:Hemoglobins / Q000627:therapeutic use*; D008297:Male; D008863:Microspheres; D010179:Pancreas / Q000098:blood supply*; D012039:Regional Blood Flow / Q000187:drug effects; D012079:Renal Circulation / Q000187:drug effects*; D012151:Resuscitation; D012709:Serum Albumin / Q000627:therapeutic use; D012771:Shock, Hemorrhagic / Q000503:physiopathology* / Q000628:therapy*; D013552:Swine
D001802:Blood Substitutes; D006454:Hemoglobins; D012709:Serum Albumin; C083478:diaspirin-cross-linked hemoglobin; D001241:Aspirin