title: What If I Don't Have Blood? Hextend is Superior to 3% Saline in an Experimental Model of Far Forward Resuscitation After Hemorrhage.
abstract: Hypertonic crystalloid solutions, colloids, and fresh whole blood (FWB) have all been proposed for prehospital resuscitation after hemorrhage. However, there are no direct comparisons of the efficacy of these different fluids. We compared Hextend, 3% hypertonic saline (HS), and FWB in a porcine model of hemorrhagic shock.
  
  
  
  Female swine (n = 5/group) underwent splenectomy and pressure-controlled hemorrhage followed by resuscitation with Hextend, 3% HS, or FWB. They were maintained at a target mean arterial pressure (MAP) for 4 h, holding or infusing fluid as necessary. Sham animals for comparison underwent splenectomy alone.
  
  
  
  The mean volume required to maintain target MAP was significantly higher for 3% HS (1,016 ± 386 mL) than for Hextend (346 ± 299 mL, P < 0.05). After 4 h of resuscitation, the MAP in the 3% HS group (44 ± 3 mmHg) was significantly lower than shams (56 ± 7 mmHg, P < 0.05). Three percent HS recipients had a significantly worse metabolic acidosis and anemia than shams or FWB recipients, as well as significant increases in serum sodium and chloride. Serum interleukin-6 was significantly elevated in 3% HS and FWB recipients relative to Hextend recipients (105.3 ± 58.6 and 97.2 ± 21 vs. 38.6 ± 27.1 pcg/mL, P < 0.05).
  
  
  
  HS performed inferiorly to Hextend as a volume expanding resuscitative fluid after hemorrhage. On the basis of our data, we would recommend the use of Hextend over 3% saline in far forward resuscitation after hemorrhage.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery and the Institute for Military Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Jernigan
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.forename: Daniel
authors.initials: D
authors.lastname: Cox
authors.forename: Judy
authors.initials: J
authors.lastname: Heyl
authors.forename: Warren C
authors.initials: WC
authors.lastname: Dorlac
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Pritts
mesh_terms: D000818:Animals; D062186:Arterial Pressure; D001794:Blood Pressure / Q000502:physiology; D001803:Blood Transfusion; D004195:Disease Models, Animal; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects; D006470:Hemorrhage / Q000628:therapy*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D015850:Interleukin-6 / Q000378:metabolism; D012151:Resuscitation / Q000379:methods*; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use*; D013156:Splenectomy; D013552:Swine; D016896:Treatment Outcome
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D015850:Interleukin-6; D012462:Saline Solution, Hypertonic