title: Bovine polymerized hemoglobin versus Hextend resuscitation in a swine model of severe controlled hemorrhagic shock with delay to definitive care.
abstract: To compare the efficacy of low-volume resuscitation with bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in an intermediate severity combat-relevant hemorrhagic shock swine model with a simulated delay to hospital care. Twenty-four anesthetized pigs were hemorrhaged 55% estimated blood volume in conjunction with a 5-min rectus abdominus crush. At 20 min, pigs were resuscitated with 10 mL/kg of HBOC-201 or HEX or nothing (NON); resuscitated pigs received additional infusions (5 mL/kg) at 30, 60, 120, or 180 min if hypotension or tachycardia persisted. Pigs were monitored for a 4-h "prehospital" period. At 4-h, hospital arrival was simulated: surgical sites were repaired, blood, or saline provided, and pigs were recovered from anesthesia. Pigs were monitored for 72 h and then killed for histological evaluation. One hundred percent (8/8) of HBOC-201-, 75% (6/8) of HEX-, and 25% (2/8) of NON-resuscitated pigs survived to 72 h (P = 0.007 overall, HBOC vs. HEX P > 0.05). Mean arterial pressure and mean pulmonary arterial pressure were highest in the HBOC-201 group (P < 0.001), and HR was lowest (P < 0.001). HBOC-201- and HEX-resuscitated pigs had comparable cardiac index and prehospital fluid requirements. HBOC-201 pigs had higher transcutaneous tissue oxygen tension, P < 0.001) and lower urine output (P < 0.001). At simulated hospital arrival, no HBOC-201 pigs required additional fluids or blood transfusion. In contrast, 100% of HEX pigs required blood transfusions (P < 0.01). In this swine model of controlled hemorrhage with low-volume resuscitation and delayed definitive care, HBOC-201 pigs had improved hemodynamics, transcutaneous tissue oxygen tension, and transfusion avoidance compared with HEX.
authors.affiliation: Naval Medical Research Center, Silver Spring, MD 20910, USA. ricej@nmrc.navy.mil
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rice
authors.forename: Nora
authors.initials: N
authors.lastname: Philbin
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Françoise
authors.initials: F
authors.lastname: Arnaud
authors.forename: Todd
authors.initials: T
authors.lastname: Johnson
authors.forename: W Shannon
authors.initials: WS
authors.lastname: Flournoy
authors.forename: L Bruce
authors.initials: LB
authors.lastname: Pearce
authors.forename: Richard
authors.initials: R
authors.lastname: McCarron
authors.forename: Lew
authors.initials: L
authors.lastname: Kaplan
authors.forename: Michael
authors.initials: M
authors.lastname: Handrigan
authors.forename: Daniel
authors.initials: D
authors.lastname: Freilich
mesh_terms: D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D001802:Blood Substitutes / Q000627:therapeutic use; D001831:Body Temperature; D002417:Cattle; D004195:Disease Models, Animal; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate / Q000502:physiology; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis / Q000627:therapeutic use*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D011108:Polymers / Q000627:therapeutic use*; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D016019:Survival Analysis; D013552:Swine; D013556:Swine, Miniature; D014508:Urea / Q000652:urine
chemical_list: D001802:Blood Substitutes; D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D011108:Polymers; C080663:polymerized bovine hemoglobin; C096798:HBOC 201; D019344:Lactic Acid; D014508:Urea