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A hemoglobin based oxygen carrier, bovine polymerized hemoglobin (HBOC-201) versus Hetastarch (HEX) in an uncontrolled liver injury hemorrhagic shock swine model with delayed evacuation.

AbstractBACKGROUND:
As HBOC-201 improves outcome in animals with hemorrhagic shock (HS), we compared HBOC-201 and HEX (used by U.S. military special operations forces) in a swine model of delayed evacuation and uncontrolled HS.
METHODS:
Twenty-four Yucatan pigs underwent a grade III liver injury and were resuscitated with HBOC-201, HEX, or no fluid (NON). Additional infusions were given for hypotension or tachycardia. After 4 hours, the liver was repaired; IV fluids and blood transfusions were administered. Pigs were monitored for 72 hours.
RESULTS:
Survival was 7/8, 1/8, and 1/8 in HBOC-201-, HEX-, and NON-resuscitated pigs, respectively. Compared with HEX, HBOC-201 pigs had higher systemic and pulmonary artery pressures and had comparable cardiac outputs, but were less tachycardic. Transcutaneous tissue oxygenation was restored more rapidly in HBOC-201 pigs, there was a trend to lower lactic acid, and base deficit was less. HBOC-201 pigs had lower fluid requirements, higher urine output, and lower blood loss than HEX pigs.
CONCLUSIONS:
Despite evidence of vasoactivity, HBOC-201 more effectively stabilized tissue oxygenation, reversed anaerobic metabolism, decreased bleeding, and increased survival in comparison with HEX. If confirmed in clinical trials, these data suggest that for the resuscitation of combat casualties with delayed evacuation and uncontrolled HS due to solid organ injury, HBOC-201 is a superior low-volume resuscitative fluid.
AuthorsJennifer Gurney, Nora Philbin, Jennifer Rice, Françoise Arnaud, Feng Dong, Meghan Wulster-Radcliffe, L Bruce Pearce, Lewis Kaplan, Richard McCarron, Daniel Freilich
JournalThe Journal of trauma (J Trauma) Vol. 57 Issue 4 Pg. 726-38 (Oct 2004) ISSN: 0022-5282 [Print] United States
PMID15514525 (Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)
Chemical References
  • Blood Substitutes
  • Hemoglobins
  • Hydroxyethyl Starch Derivatives
  • hemoglobin polymer
  • Oxygen
Topics
  • Animals
  • Blood Substitutes (pharmacology)
  • Cattle
  • Disease Models, Animal
  • Female
  • Hemodynamics (drug effects)
  • Hemoglobins
  • Hydroxyethyl Starch Derivatives (pharmacology)
  • Infusions, Intravenous
  • Injury Severity Score
  • Liver (injuries)
  • Male
  • Oxygen (blood)
  • Probability
  • Random Allocation
  • Resuscitation (methods)
  • Sensitivity and Specificity
  • Shock, Hemorrhagic (mortality, therapy)
  • Survival Rate
  • Swine
  • Vascular Resistance (drug effects)

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