title: Resuscitation with Lyophilized Plasma Is Safe and Improves Neurological Recovery in a Long-Term Survival Model of Swine Subjected to Traumatic Brain Injury, Hemorrhagic Shock, and Polytrauma.
abstract: We have shown previously that fresh frozen plasma (FFP) and lyophilized plasma (LP) decrease brain lesion size and improve neurological recovery in a swine model of traumatic brain injury (TBI) and hemorrhagic shock (HS). In this study, we examine whether these findings can be validated in a clinically relevant model of severe TBI, HS, and polytrauma. Female Yorkshire swine were subjected to TBI (controlled cortical impact), hemorrhage (40% volume), grade III liver and splenic injuries, rib fracture, and rectus abdominis crush. The animals were maintained in a state of shock (mean arterial pressure 30-35 mm Hg) for 2 h, and then randomized to resuscitation with normal saline (NS), FFP, or LP (n = 5 swine/group). Animals were recovered and monitored for 30 d, during which time neurological recovery was assessed. Brain lesion sizes were measured via magnetic resonance imaging (MRI) on post-injury days (PID) three and 10. Animals were euthanized on PID 30. The severity of shock and response to resuscitation was similar in all groups. When compared with NS-treated animals, plasma-treated animals (FFP and LP) had significantly lower neurologic severity scores (PID 1-7) and a faster return to baseline neurological function. There was no significant difference in brain lesion sizes between groups. LP treatment was well tolerated and similar to FFP. In this clinically relevant large animal model of severe TBI, HS, and polytrauma, we have shown that plasma-based resuscitation strategies are safe and result in neurocognitive recovery that is faster than recovery after NS-based resuscitation.
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Georgoff
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Vahagn C
authors.initials: VC
authors.lastname: Nikolian
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Ihab
authors.initials: I
authors.lastname: Halaweish
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Kiril
authors.initials: K
authors.lastname: Chtraklin
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bruhn
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Hassan
authors.initials: H
authors.lastname: Eidy
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Monica
authors.initials: M
authors.lastname: Rasmussen
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Li
authors.affiliation: 2 Department of Radiology, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Ashok
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: 1 Department of Surgery, Section of Neuroradiology, University of Michigan , Ann Arbor, Michigan.
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Alam
mesh_terms: D000818:Animals; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005612:Freeze Drying; D008279:Magnetic Resonance Imaging; D023421:Models, Animal; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010949:Plasma; D020127:Recovery of Function / Q000502:physiology*; D012151:Resuscitation / Q000379:methods*; D012771:Shock, Hemorrhagic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013552:Swine; D016896:Treatment Outcome
keywords: fresh frozen plasma; hemorrhagic shock; lyophilized plasma; polytrauma; traumatic brain injury