title: Effects of a combination hemoglobin based oxygen carrier-hypertonic saline solution on oxygen transport in the treatment of traumatic shock.
abstract: BACKGROUND
  Logistics complicate fluid resuscitation of traumatic shock on the battlefield. Traumatic shock can result in oxygen debt (O(2)D) accumulation that is fatal. However, the ability of fluid strategies to repay O(2)D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O(2)D in traumatic shock.
  
  
  METHODS
  41 anesthetized swine underwent hemorrhage to an O(2)D of 80 mL/kg. Animals received one of the following: 500 mL whole blood, 500 mL AfterShock™, 500 mL hypertonic (7.2%) saline, 250 mL hypertonic (7.2%) saline, 500 mL Hetastarch (6%), or 500 mL lactated Ringer's. Oxygen transport variables (O(2)D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood.
  
  
  RESULTS
  Only animals receiving AfterShock™, 500 mL hypertonic saline, and 500 mL Hetastarch survived to 180 min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O(2)D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500 mL hypertonic saline groups.
  
  
  CONCLUSIONS
  Use of 500 mL AfterShock™, 500 mL of 7.2% saline or 500 mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O(2)D. These findings may have implications for designing resuscitation fluids for combat casualty care.
authors.affiliation: Virginia Commonwealth University, Reanimation Engineering Science Center, 600 E. Broad Street, Richmond, VA 23298, USA. leong benjamin@yahoo.com.sg
authors.forename: Benjamin
authors.initials: B
authors.lastname: Leong
authors.forename: Penny S
authors.initials: PS
authors.lastname: Reynolds
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Tiba
authors.forename: William H
authors.initials: WH
authors.lastname: Holbert
authors.forename: Gerard T
authors.initials: GT
authors.lastname: Draucker
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Medina
authors.forename: Robert W
authors.initials: RW
authors.lastname: Barbee
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: White
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Ward
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D005440:Fluid Therapy / Q000379:methods*; D006454:Hemoglobins / Q000008:administration & dosage*; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D008297:Male; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000502:physiology*; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000008:administration & dosage; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012774:Shock, Traumatic / Q000097:blood / Q000628:therapy*; D034421:Sus scrofa; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D010100:Oxygen