A hemoglobin-based oxygen carrier, bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in a moderate severity hemorrhagic shock swine model with delayed evacuation.

Academic Article

Abstract

  • OBJECTIVE: To evaluate the efficacy of HBOC-201 for resuscitation of hemorrhagic shock in a swine model incorporating soft tissue injury and delayed evacuation. METHODS: A muscle crush injury and 40% estimated blood volume controlled hemorrhage was completed in 24 Yucatan mini-pigs. Pigs were untreated or resuscitated with HBOC-201 or 6% hetastarch (HEX) at 20 min. Invasive hemodynamics and clinical variables were monitored for 4 h (pre-hospital phase) and subsequent fluid infusions were administered for severe hypotension or tachycardia. Animals were recovered from anesthesia and monitored non-invasively to 72 h (hospital phase). RESULTS: 100% (8/8) of HBOC-201-, 88% (7/8) of HEX-, and 63% (5/8) of non-resuscitated pigs, survived to 72 h (p=0.27). Mean arterial pressure, mean pulmonary arterial pressure and systemic vascular resistance index were higher in HBOC-201 pigs. By 90 min, cardiac index was restored to baseline in the HBOC-201 group and was 1.4-fold greater than baseline in the HEX group. HBOC-201 pigs had lower fluid requirements than HEX pigs (18.8+/-1.8 and 29.9+/-1.1 ml/kg, p<0.001) in the pre-hospital phase and required fewer blood transfusions (1.3+/-1.3 and 9.4+/-0.6 ml/kg, respectively, p<0.001) in the hospital phase. Urine output and blood creatinine were comparable in HBOC-201 and HEX pigs. Tissue oxygenation levels were highest in the HBOC-201 group. CONCLUSIONS: As HBOC-201 restored hemodynamics and tissue oxygenation and decreased fluid requirements, in comparison with HEX, HBOC-201 was at least as efficacious and possibly a superior resuscitative fluid in a military-relevant delayed evacuation hemorrhagic shock swine model.
  • Authors

    Published In

  • Resuscitation  Journal
  • Keywords

  • Animals, Blood Substitutes, Cardiopulmonary Resuscitation, Disease Models, Animal, Emergency Medical Services, Female, Hematocrit, Hemodynamics, Hemoglobins, Hydroxyethyl Starch Derivatives, Kidney, Male, Military Medicine, Oxygen, Shock, Hemorrhagic, Survival Analysis, Swine, Swine, Miniature, Treatment Outcome, Water-Electrolyte Balance
  • Digital Object Identifier (doi)

    Author List

  • Philbin N; Rice J; Gurney J; McGwin G; Arnaud F; Dong F; Johnson T; Flournoy WS; Ahlers S; Pearce LB
  • Start Page

  • 367
  • End Page

  • 378
  • Volume

  • 66
  • Issue

  • 3