Hemoglobin solutions have demonstrated a pressor effect that could adversely affect
hemorrhagic shock patient
resuscitation through accelerated
hemorrhage, diminished perfusion, or inadequate
resuscitation. Data from two parallel, multicenter traumatic
hemorrhagic shock clinical trials in 17 US emergency departments and in 27 EU prehospital systems using
diaspirin cross-linked hemoglobin (
DCLHb), a
hemoglobin-based
resuscitation fluid. In the 219 patients, patients were 37 years old, 64% sustained
blunt injury, 48% received
DCLHb, and 36% expired. Although mean systolic blood pressure (SBP) and diastolic blood pressure values differed at 2 of the 10 measured time points, blood pressure (BP) curve analysis showed no SBP, diastolic blood pressure, or MAP differences based on treatment. Although SBP values 160 and 120 mmHg or greater were 2.2x and 2.6x more frequently noted in survivors, they were not more common with
DCLHb use or in
DCLHb patients who expired in US study nonsurvivors or in any EU study patients. Systolic blood pressure values 160 and 120 mmHg or greater were 2.8x and 1.3x more frequently noted in
DCLHb survivors as compared with
normal saline survivors. Only 3% of the BP variation noted could be attributed to
DCLHb use, and as expected, injury severity and baseline physiologic status were stronger predictors. In the United States alone, treatment group was not correlated by regression with BP at any time point. Neither mean BP readings nor elevated BP readings were correlated with
DCLHb treatment of traumatic
hemorrhagic shock patients. As such, no clinically demonstrable
DCLHb pressor effect could be directly related to the adverse mortality outcome observed in the US study.