A hemoglobin-based oxygen carrier, bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in a moderate severity hemorrhagic shock swine model with delayed evacuation.
OBJECTIVE
To evaluate the efficacy of HBOC-201 for resuscitation of hemorrhagic shock in a swine model incorporating soft tissue injury and delayed evacuation.


METHODS
A muscle crush injury and 40% estimated blood volume controlled hemorrhage was completed in 24 Yucatan mini-pigs. Pigs were untreated or resuscitated with HBOC-201 or 6% hetastarch (HEX) at 20 min. Invasive hemodynamics and clinical variables were monitored for 4 h (pre-hospital phase) and subsequent fluid infusions were administered for severe hypotension or tachycardia. Animals were recovered from anesthesia and monitored non-invasively to 72 h (hospital phase).


RESULTS
100% (8/8) of HBOC-201-, 88% (7/8) of HEX-, and 63% (5/8) of non-resuscitated pigs, survived to 72 h (p=0.27). Mean arterial pressure, mean pulmonary arterial pressure and systemic vascular resistance index were higher in HBOC-201 pigs. By 90 min, cardiac index was restored to baseline in the HBOC-201 group and was 1.4-fold greater than baseline in the HEX group. HBOC-201 pigs had lower fluid requirements than HEX pigs (18.8+/-1.8 and 29.9+/-1.1 ml/kg, p<0.001) in the pre-hospital phase and required fewer blood transfusions (1.3+/-1.3 and 9.4+/-0.6 ml/kg, respectively, p<0.001) in the hospital phase. Urine output and blood creatinine were comparable in HBOC-201 and HEX pigs. Tissue oxygenation levels were highest in the HBOC-201 group.


CONCLUSIONS
As HBOC-201 restored hemodynamics and tissue oxygenation and decreased fluid requirements, in comparison with HEX, HBOC-201 was at least as efficacious and possibly a superior resuscitative fluid in a military-relevant delayed evacuation hemorrhagic shock swine model.
Philbin
Nora
N
Naval Medical Research Center, Combat Casualty Care, 2N77 503 Robert Grant Avenue, Silver Spring, MD 20910, USA. philbinn@nmrc.navy.mil
Rice
Jennifer
J
Gurney
Jennifer
J
McGwin
Gerald
G
Arnaud
Françoise
F
Dong
Feng
F
Johnson
Todd
T
Flournoy
W Shannon
WS
Ahlers
Stephen
S
Pearce
L Bruce
LB
McCarron
Richard
R
Freilich
Daniel
D
D000818:Animals; D001802:Blood Substitutes / Q000627:therapeutic use*; D016887:Cardiopulmonary Resuscitation / Q000295:instrumentation* / Q000379:methods; D004195:Disease Models, Animal; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects; D006454:Hemoglobins / Q000627:therapeutic use*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D008887:Military Medicine / Q000295:instrumentation; D010100:Oxygen / Q000378:metabolism; D012771:Shock, Hemorrhagic / Q000188:drug therapy* / Q000378:metabolism; D016019:Survival Analysis; D013552:Swine; D013556:Swine, Miniature; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance / Q000187:drug effects
D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; C096798:HBOC 201; D010100:Oxygen