title: Low-volume resuscitation cocktail extends survival after severe hemorrhagic shock.
abstract: After severe hemorrhage, low-volume resuscitation with hypertonic fluids is increasingly preferred to more aggressive resuscitation strategies. Oxygen delivery to the tissues may be improved by augmentation with hemoglobin [Hb]-based oxygen-carrying compounds (HBOCs); however, previous studies have reported negative outcomes presumably related to extravasation of tetrameric Hb. The purpose of this study was to evaluate a novel large molecular weight polymer of cross-linked bovine Hb (OxyVita; OXYVITA Inc, New Windsor, NY) in a cocktail of hypertonic saline and Hextend (HX; HBOC-C) as an alternative to standard small-volume resuscitation using Hextend (HX) only. Outcomes were survival to 3 h and duration of MAP support more than 60 mmHg without additional fluid support. Conscious male Long-Evans rats were hemorrhaged to 60% total blood volume over 40 min. There were 4 groups: HBOC-C administered in a pressure-titrated infusion, HX titration, HBOC-C administered as a bolus, and HX bolus. Cardiovascular parameters, arterial gases, acid-base status, metabolites, electrolytes, Hb level, and oxygen saturation were measured at baseline, during each 20% hemorrhage increment, and 1, 2, and 3 h after the initiation of hemorrhage. Small-volume resuscitation with HBOC-C significantly improved survival to 3 h and improved MAP support times regardless of method of administration. However, physiological status at the end of hemorrhage significantly influenced survival regardless of resuscitation treatment. These results suggest that HBOC-augmented hypertonic cocktails are of promise in improving survival and providing target MAP support during small-volume resuscitation. Experimental evaluation of any resuscitation therapy should account for the degree of preexisting physiological compromise before therapy is initiated.
authors.affiliation: Departments of Emergency Medicine, Virginia Commonwealth University Reanimation Engineering Shock Center, Virginia Commonwealth University Medical Center, Richmond, Virginia 23298-0401, USA. psreynolds@vcu.edu
authors.forename: Penny S
authors.initials: PS
authors.lastname: Reynolds
authors.forename: R Wayne
authors.initials: RW
authors.lastname: Barbee
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Skaflen
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ward
mesh_terms: D000818:Animals; D001794:Blood Pressure; D001802:Blood Substitutes / Q000008:administration & dosage*; D002417:Cattle; D003432:Cross-Linking Reagents; D004195:Disease Models, Animal; D006454:Hemoglobins / Q000008:administration & dosage / Q000737:chemistry; D006801:Humans; D008297:Male; D051381:Rats; D020318:Rats, Long-Evans; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012771:Shock, Hemorrhagic / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
chemical_list: D001802:Blood Substitutes; D003432:Cross-Linking Reagents; D006454:Hemoglobins; D012462:Saline Solution, Hypertonic