HBOC-201 use in traumatic brain injury: case report and review of literature.
BACKGROUND
The first use of HBOC-201 in severe traumatic brain injury (TBI) is presented. The use of noninvasive cerebral oximetric devices to follow clinical progress in a patient infused with HBOC-201 is reported and the literature of hemoglobin-based oxygen carriers (HBOCs) in brain injury is reported.


METHODS
A 21-year-old Jehovah's Witness who was hit and dragged by a motor vehicle was admitted to the University of New Mexico Hospital Level 1 Trauma Center Trauma Surgical Intensive Care Unit with severe TBI and extensive soft tissue loss resulting in profound anemia. The patient received infusion of HBOC-201 with regional and global oximetric monitoring.


RESULTS
Chart abstraction was performed to identify clinically relevant physiologic markers of patient progress. We observed a marked increase in brain tissue oxygen saturations, central venous oxygen saturation, and hemodynamic variables after administration of HBOC-201. The patient subsequently suffered massive cerebral edema and died.


CONCLUSIONS
Major HBOC trials to date have excluded severe TBI. We report the first use of an HBOC in severe TBI to correct profound anemia. The HBOC-201 rapidly corrected cerebral venous and central venous oxygen saturations. The patient's death may have been due to massive reperfusion injury from delayed repayment of cerebral oxygen debt in a severely ischemic brain.
Marinaro
Jonathan
J
Department of Surgery, University of New Mexico, Albuquerque, New Mexico 87131-0001, USA. jmarinaro@salud.unm.edu
Smith
Jessica
J
Tawil
Isaac
I
Billstrand
Mary
M
Crookston
Kendall P
KP
D001802:Blood Substitutes / Q000627:therapeutic use*; D001930:Brain Injuries / Q000628:therapy*; D006454:Hemoglobins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
D001802:Blood Substitutes; D006454:Hemoglobins; C096798:HBOC 201