Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution.
BACKGROUND
Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All i.v. fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation.


METHODS
Using thrombelastometry (ROTEM), we studied 30 pigs (weighing 35-45 kg) after withdrawal of 60% of blood volume [1484 mL (1369-1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, alpha angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured.


RESULTS
Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures.


CONCLUSIONS
Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.
Haas
Thorsten
T
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. thorsten.haas@i-med.ac.at
Fries
Dietmar
D
Holz
Carmen
C
Innerhofer
Petra
P
Streif
Werner
W
Klingler
Anton
A
Hanke
Alexander
A
Velik-Salchner
Corinna
C
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D005780:Gelatin / Q000627:therapeutic use; D006439:Hemodynamics; D006487:Hemostasis; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D011651:Pulmonary Artery / Q000502:physiology; D012151:Resuscitation; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D012771:Shock, Hemorrhagic / Q000628:therapy*; D013552:Swine
D006895:Hydroxyethyl Starch Derivatives; D012462:Saline Solution, Hypertonic; D005780:Gelatin