Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution.

Abstract

BACKGROUND:

Small-volume resuscitation using hypertonic saline/hydroxyethyl starch 200/0.62 (HS-HES) has been shown to be an effective alternative to the administration of crystalloids or colloids in trauma patients. All i.v. fluids cause dose-related dilutional coagulopathy and show intrinsic effects on the hemostatic system, but only few data refer to functional consequences after small-volume resuscitation.

METHODS:

Using thrombelastometry (ROTEM), we studied 30 pigs (weighing 35-45 kg) after withdrawal of 60% of blood volume [1484 mL (1369-1624 mL)] and receiving 4 mL/kg HS-HES for compensation of blood loss or 4% gelatin or 6% HES 130/0.4 in a 1:1 ratio to lost blood volume. To compare the ROTEM variables (coagulation time, clot formation time, alpha angle, clot firmness, and fibrinogen polymerization) with bleeding tendency, a hepatic incision was made and blood loss was measured.

RESULTS:

Median (25th, 75th percentile) fibrinogen polymerization was significantly higher after HS-HES infusion [11 mm (10, 11), P = 0.0034] when compared with administration of 4% gelatin [4.5 mm (3.0, 5.8)] or HES 130/0.4 [3.5 mm (2.3, 4.0)]. Median blood loss after liver incision was 725 mL (900, 375) after HS-HES, 1625 mL (1275, 1950) after 4% gelatin, and 1600 mL (1500, 1800) after 6% HES 130/0.4 (P = 0.004). Hemodynamic stabilization was traceable in all groups but showed differences regarding filling pressures.

CONCLUSIONS:

Resuscitation from hemorrhagic shock with HS-HES 200/0.62 results in less impairment of clot formation when compared with compensation of blood loss by administering 6% HES 130/0.4 or 4% gelatin.

• Authors: Thorsten Haas, Dietmar Fries, Carmen Holz, Petra Innerhofer, Werner Streif, Anton Klingler, Alexander Hanke, Corinna Velik-Salchner
• Journal: Anesthesia and analgesia (Anesth Analg) Vol. 106 Issue 4 Pg. 1078-86, table of contents (Apr 2008) ISSN: 1526-7598 [Electronic] United States
• PMID: 18349176 (Publication Type: Journal Article)

Chemical References

• Hydroxyethyl Starch Derivatives
• Saline Solution, Hypertonic
• Gelatin

Topics

• Animals
• Blood Loss, Surgical (prevention & control)
• Blood Volume
• Gelatin (therapeutic use)
• Hemodynamics
• Hemostasis
• Hydroxyethyl Starch Derivatives (therapeutic use)
• Pulmonary Artery (physiology)
• Resuscitation
• Saline Solution, Hypertonic (therapeutic use)
• Shock, Hemorrhagic (therapy)
• Swine