title: Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model.
abstract: BACKGROUND
  Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability.
  
  
  METHODS
  There were 20 anesthetized swine (35 +/- 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0') and study end (120'). Thrombelastography was performed at 0'and postinjury at 30', 60', 90', and 120'.
  
  
  RESULTS
  There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p < 0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p < 0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009).
  
  
  CONCLUSIONS
  This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.
authors.affiliation: Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: Laszlo N
authors.initials: LN
authors.lastname: Kiraly
authors.forename: Jerome A
authors.initials: JA
authors.lastname: Differding
authors.forename: T Miko
authors.initials: TM
authors.lastname: Enomoto
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sawai
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Muller
authors.forename: Brian
authors.initials: B
authors.lastname: Diggs
authors.forename: Brandon H
authors.initials: BH
authors.lastname: Tieu
authors.forename: Michael S
authors.initials: MS
authors.lastname: Englehart
authors.forename: Samantha
authors.initials: S
authors.lastname: Underwood
authors.forename: Tracy T
authors.initials: TT
authors.lastname: Wiesberg
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006487:Hemostasis / Q000187:drug effects*; D007552:Isotonic Solutions / Q000494:pharmacology* / Q000627:therapeutic use; D011897:Random Allocation; D000077325:Ringer's Lactate; D012771:Shock, Hemorrhagic / Q000628:therapy*; D012965:Sodium Chloride / Q000494:pharmacology* / Q000627:therapeutic use; D013552:Swine; D013916:Thrombelastography
chemical_list: D007552:Isotonic Solutions; D000077325:Ringer's Lactate; D012965:Sodium Chloride