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Abstract
Current recommendations for the preoperative management of hemorrhagic shock include
the initial infusion of 2 L of isotonic crystalloid regardless of the severity of
hemorrhage. While this approach may be adequate for patients who experience only mild
to moderate hemorrhagic insults, it has never been tested in a clinically relevant
model of severe life-threatening hemorrhage. The authors used a porcine model of rapidly
fatal hemorrhage with a reproducible and relevant physiologic end-point, the absence
of vital signs, to test the hypothesis that even brief delays in blood replacement
may result in higher mortality rates and worsen hemodynamic and metabolic responses
to hemorrhage. Twenty-four immature swine (11–17 kg) were bled continuously at a decelerating
rate until the following criteria were met: (1) respiratory arrest, (2) a pulse pressure
of 0 and, (3) a slowing of cardiac electrical activity of 15% or more. Resuscitation
was begun 1 minute later. The animals were randomly assigned to one of three resuscitation
regimens. Group A (n = 8) received shed blood at a rate of 3 mL/kg/min for 10 minutes
followed by normal saline (NS) at a rate of 3 mL/kg/min for 10 minutes. Group B (n
= 8) received NS at a rate of 3 mL/kg/min for 10 minutes followed by shed blood at
a rate of 3 mL/kg/min for 10 minutes. Group C, controls, (n = 8) received NS at a
rate of 3 mL/kg/min for 20 minutes. Animals were observed for 30 minutes after resuscitation
or until death. Mortality was 25%, 37.5%, and 100% for groups A, B, and C, respectively
(P < .05 for group C versus group A or B). The group A animals demonstrated better hemodynamic
and metabolic profiles throughout the resuscitation and observation periods as compared
with the animals in groups B and C. The authors conclude that in the near-fatal hemorrhagic
shock model, crystalloids are not the ideal initial resuscitation agent; even brief
delays in blood replacement result in worse biochemical and hemodynamic response to
the hemorrhagic insult.
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Article Info
Publication History
Accepted:
June 25,
1992
Received:
August 30,
1991
Footnotes
☆Presented at the annual meeting of the Society for Academic Emergency Medicine held in Minneapolis, MN, May 1990.
☆☆This project was supported by the University of Cincinnati Department of Emergency Medicine Resident Research Fund.
Identification
Copyright
© 1992 Published by Elsevier Inc.
