Improved outcome with early blood administration in a near-fatal model of porcine hemorrhagic shock

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      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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        • Shires T
        • Coln D
        • Carrico J
        • et al.
        Fluid therapy in hemorrhagic shock.
        Am J Emerg Med. 1964; 88: 688-693
        • Dillon J
        • Lynch LJ
        • Myers R
        • et al.
        The treatment of hemorrhagic shock.
        Surg Gynecol Obstet. 1966; 122: 967-978
        • Wolfman EF
        • Neill SA
        • Heaps DK
        • et al.
        Donor blood and isotonic salt solution.
        Arch Surg. 1963; 86: 869-873
        • American College of Surgeons
        ed 4. Advanced Trauma Life Support. American College of Surgeons, Chicago, IL1988: 59-73
        • MeBmer K
        • Sunder-Plassmann L
        • Jesch F
        • et al.
        Oxygen supply to the tissues during limited normovolemic hemodilution.
        Res Exp Med. 1973; 159: 152-166
        • Pruitt BA
        • Moncrief JA
        • Mason AD
        Efficacy of buffered saline as the sole replacement fluid following acute measured hemorrhage in man.
        J Trauma. 1967; 7: 767-782
        • Traverso LW
        • Stanley JH
        • Bolin RB
        • et al.
        Fluid resuscitation after an otherwise fatal hemorrhage. II. Colloid solutions.
        J Trauma. 1986; 26: 176-182
        • Shoemaker WC
        Comparison of the relative effectiveness of whole transfusions and various types of fluid therapy in resuscitation.
        Crit Care Med. 1976; 4: 71-78
        • Moss GS
        • Proctor HJ
        • Homer LD
        • et al.
        A comparison of asanguineous fluids and whole blood in the treatment of hemorrhagic shock.
        Surg Gynecol Obstet. 1969; 129: 1247-1257
        • Millikan JS
        • Cain TL
        • Hansbrough J
        Rapid volume replacement for hypovolemic shock: A comparison of techniques and equipment.
        J Trauma. 1984; 24: 428-431
        • Gump FE
        • Butler H
        • Kinney JM
        Oxygen transport and consumption during acute hemodilution.
        Ann Surg. 1968; 168: 54-60
        • Rush B
        • Eiseman B
        Limits of non-colloid solution replacement in experimental hemorrhagic shock.
        Ann Surg. 1967; 165: 977-984
        • Traverso LW
        • Medina F
        • Bolin RB
        The buffering capacity of crystalloid and colloid resuscitation solutions.
        Resuscitation. 1985; 12: 265-270
        • Bergman GE
        • Propp DA
        Transfusion therapy: Blood and blood products.
        in: Roberts JR Hedges JR Clinical Procedures in Emergency Medicine. Saunders, Philadelphia, PA1991: 405
        • Iserson KV
        High-flow infusion techniques.
        in: Roberts JR Hedges JR Clinical Procedures in Emergency Medicine. Saunders, Philadelphia, PA1991: 301-307
        • Mateer JR
        • Thompson BM
        • Aprahamian JC
        • et al.
        Rapid fluid resuscitation with central venous catheters.
        Ann Emerg Med. 1983; 12: 149-152
        • Iserson KV
        • Reeter AK
        Rapid fluid replacement: A new methodology.
        Ann Emerg Med. 1984; 13: 97-100
        • Zorko MF
        • Polsky SS
        Rapid warming and infusion of packed red blood cells.
        Ann Emerg Med. 1986; 15: 907-910
        • Repogle RL
        • Jundler H
        • Gross RE
        Studies on the hemodynamic importance of blood viscosity.
        J Thorac Cardiovasc Surg. 1965; 50: 658-668
        • Schenk WG
        • Delin NA
        • Domanig E
        • et al.
        Blood viscosity as a determinant of regional blood flow.
        Arch Surg. 1964; 89: 783-796
        • Rosenblatt R
        • Dennis P
        • Draper DL
        A new method for massive fluid resuscitation in the trauma patient.
        Anesth Analg. 1983; 62: 613-616