Abstract | OBJECT: METHODS: Swine underwent brain impact injury and hemorrhage to a mean arterial pressure (MAP) of 40 mm Hg. Twenty swine were randomized to undergo resuscitation with HBOC-201 (6 ml/kg) or LR solution (12 ml/kg) and were observed for an average of 6.5 +/- 0.5 hours following resuscitation. At the end of the observation period, magnetic resonance (MR) imaging was performed. Histological studies of swine brains were performed using Fluoro-Jade B, a marker of early neuronal degeneration. RESULTS: Swine resuscitated with HBOC-201 had higher MAP, higher cerebral perfusion pressure ( CPP), improved base deficit, and higher brain tissue oxygen tension ( PbtO(2)) than animals resuscitated with LR solution. No significant difference in total injury volume on T2-weighted MR imaging was observed between animals resuscitated with HBOC-201 solution (1155 +/- 374 mm(3)) or LR solution (1246 +/- 279 mm(3); p = 0.55). On the side of impact injury, no significant difference in the mean number of Fluoro-Jade B-positive cells/hpf was seen between HBOC-201 solution (61.5 +/- 14.7) and LR solution (48.9 +/- 17.7; p = 0.13). Surprisingly, on the side opposite impact injury, a significant increase in Fluoro-Jade B-positive cells/hpf was seen in animals resuscitated with LR solution (42.8 +/- 28.3) compared with those resuscitated with HBOC-201 solution (5.6 +/- 8.1; p < 0.05), implying greater neuronal injury in LR-treated swine. CONCLUSIONS: The improved MAP, CPP, and PbtO(2) observed with HBOC-201 solution in comparison with LR solution indicates that HBOC-201 solution may be a preferable agent for small-volume resuscitation in brain-injured patients with hemorrhage. The use of HBOC-201 solution appears to decrease cellular degeneration in the brain area not directly impacted by the primary injury. Hemoglobin-based oxygen-carrying-201 solution may act by improving cerebral blood flow or increasing the oxygen-carrying capacity of blood, mitigating a second insult to the injured brain.
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Authors | Guy Rosenthal, Diane Morabito, Mitchell Cohen, Annina Roeytenberg, Nikita Derugin, S Scott Panter, M Margaret Knudson, Geoffrey Manley |
Journal | Journal of neurosurgery
(J Neurosurg)
Vol. 108
Issue 3
Pg. 575-87
(Mar 2008)
ISSN: 0022-3085 [Print] United States |
PMID | 18312106
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)
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Chemical References |
- Blood Substitutes
- Hemoglobins
- HBOC 201
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Topics |
- Animals
- Blood Pressure
- Blood Substitutes
(therapeutic use)
- Brain Injuries
(complications, drug therapy, pathology)
- Disease Models, Animal
- Hemoglobins
(therapeutic use)
- Intracranial Hemorrhages
(drug therapy, etiology, pathology)
- Intracranial Pressure
- Male
- Resuscitation
- Swine
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