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Low-volume resuscitation cocktail extends survival after severe hemorrhagic shock.

Abstract
After severe hemorrhage, low-volume resuscitation with hypertonic fluids is increasingly preferred to more aggressive resuscitation strategies. Oxygen delivery to the tissues may be improved by augmentation with hemoglobin [Hb]-based oxygen-carrying compounds (HBOCs); however, previous studies have reported negative outcomes presumably related to extravasation of tetrameric Hb. The purpose of this study was to evaluate a novel large molecular weight polymer of cross-linked bovine Hb (OxyVita; OXYVITA Inc, New Windsor, NY) in a cocktail of hypertonic saline and Hextend (HX; HBOC-C) as an alternative to standard small-volume resuscitation using Hextend (HX) only. Outcomes were survival to 3 h and duration of MAP support more than 60 mmHg without additional fluid support. Conscious male Long-Evans rats were hemorrhaged to 60% total blood volume over 40 min. There were 4 groups: HBOC-C administered in a pressure-titrated infusion, HX titration, HBOC-C administered as a bolus, and HX bolus. Cardiovascular parameters, arterial gases, acid-base status, metabolites, electrolytes, Hb level, and oxygen saturation were measured at baseline, during each 20% hemorrhage increment, and 1, 2, and 3 h after the initiation of hemorrhage. Small-volume resuscitation with HBOC-C significantly improved survival to 3 h and improved MAP support times regardless of method of administration. However, physiological status at the end of hemorrhage significantly influenced survival regardless of resuscitation treatment. These results suggest that HBOC-augmented hypertonic cocktails are of promise in improving survival and providing target MAP support during small-volume resuscitation. Experimental evaluation of any resuscitation therapy should account for the degree of preexisting physiological compromise before therapy is initiated.
AuthorsPenny S Reynolds, R Wayne Barbee, Marcus D Skaflen, Kevin R Ward
JournalShock (Augusta, Ga.) (Shock) Vol. 28 Issue 1 Pg. 45-52 (Jul 2007) ISSN: 1073-2322 [Print] United States
PMID17483745 (Publication Type: Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References
  • Blood Substitutes
  • Cross-Linking Reagents
  • Hemoglobins
  • Saline Solution, Hypertonic
Topics
  • Animals
  • Blood Pressure
  • Blood Substitutes (administration & dosage)
  • Cattle
  • Cross-Linking Reagents
  • Disease Models, Animal
  • Hemoglobins (administration & dosage, chemistry)
  • Humans
  • Male
  • Rats
  • Rats, Long-Evans
  • Resuscitation (methods)
  • Saline Solution, Hypertonic (administration & dosage)
  • Shock, Hemorrhagic (physiopathology, therapy)
  • Time Factors

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