Resuscitation from hemorrhagic shock comparing standard hemoglobin-based oxygen carrier (HBOC)-201 versus 7.5% hypertonic HBOC-201.
BACKGROUND
Hemoglobin-based oxygen carrier (HBOC) resuscitation has been associated with increased systemic and pulmonary vascular resistances (SVR, PVR), which may result in reduced blood flow and severe pulmonary hypertension. The physiologic and immunologic properties of 7.5% hypertonic saline solution (HTS), such as reduction of SVR and PVR, as well as inhibition of neutrophil and endothelial activation may be beneficial in reducing some of these undesirable effects of HBOCs. The aim of this study was to evaluate the hemodynamic effects of the HBOC and HBOC-201 suspended in 7.5% hypertonic saline solution (HT-HBOC) when compared with standard HBOC resuscitation.


METHODS
Thirty-two domestic crossbred pigs (50-60 kg) were hemorrhaged to a mean arterial pressure (MAP) of 35 mm Hg +/- 5 mm Hg for 45 minutes and resuscitated to a baseline mean arterial pressure using the following groups: (1) sham, no hemorrhage; (2) shed blood + lactated Ringer's solution; (3) standard HBOC-201; (4) hypertonic saline 7.5%; (5) hypertonic 7.5% HBOC-201. After resuscitation, observation was continued for 4 hours. Hemodynamic variables, oxygen consumption, and arterial blood gases were monitored continuously. Data were analyzed using analysis of variance.


RESULTS
SVR (p = 0.001), PVR (p = 0.001), and MPAP (p = 0.01) were significantly reduced in the HT-HBOC group compared with the standard HBOC group.


CONCLUSIONS
In this model of hemorrhagic shock, hypertonic HBOC-201- resuscitated pigs had significantly reduced SVR and PVR, as well as mean pulmonary artery pressure (MPAP) and increased cardiac output. HT-HBOC may be beneficial in reducing the undesirable effects of standard HBOC-201. The mechanisms of these beneficial effects need to be investigated.
Rivera-Chavez
Fernando A
FA
Department of Surgery, Division of Burn/Trauma/Critical Care, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9160, USA. fernando.rivera@UTSW.edu
Huerta
Sergio
S
Brown
Ronnie
R
York
Gregory B
GB
Minei
Joseph P
JP
D000818:Animals; D015415:Biomarkers / Q000097:blood; D001802:Blood Substitutes / Q000008:administration & dosage*; D004195:Disease Models, Animal; D004305:Dose-Response Relationship, Drug; D006439:Hemodynamics; D006454:Hemoglobins / Q000008:administration & dosage*; D019344:Lactic Acid / Q000097:blood; D010100:Oxygen / Q000097:blood; D012016:Reference Values; D012462:Saline Solution, Hypertonic; D012771:Shock, Hemorrhagic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D012964:Sodium / Q000097:blood; D013552:Swine; D016896:Treatment Outcome
D015415:Biomarkers; D001802:Blood Substitutes; D006454:Hemoglobins; D012462:Saline Solution, Hypertonic; C096798:HBOC 201; D019344:Lactic Acid; D012964:Sodium; D010100:Oxygen