title: 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.
abstract: 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.
authors.affiliation: Walter Reed Army Medical Center (J.G.), Washington, DC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gurney
authors.forename: Nora
authors.initials: N
authors.lastname: Philbin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rice
authors.forename: Françoise
authors.initials: F
authors.lastname: Arnaud
authors.forename: Feng
authors.initials: F
authors.lastname: Dong
authors.forename: Meghan
authors.initials: M
authors.lastname: Wulster-Radcliffe
authors.forename: L Bruce
authors.initials: LB
authors.lastname: Pearce
authors.forename: Lewis
authors.initials: L
authors.lastname: Kaplan
authors.forename: Richard
authors.initials: R
authors.lastname: McCarron
authors.forename: Daniel
authors.initials: D
authors.lastname: Freilich
mesh_terms: 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
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; C079129:hemoglobin polymer; D010100:Oxygen