Bovine polymerized hemoglobin versus Hextend resuscitation in a swine model of severe controlled hemorrhagic shock with delay to definitive care.

Academic Article

Abstract

  • To compare the efficacy of low-volume resuscitation with bovine polymerized hemoglobin (HBOC-201) versus hetastarch (HEX) in an intermediate severity combat-relevant hemorrhagic shock swine model with a simulated delay to hospital care. Twenty-four anesthetized pigs were hemorrhaged 55% estimated blood volume in conjunction with a 5-min rectus abdominus crush. At 20 min, pigs were resuscitated with 10 mL/kg of HBOC-201 or HEX or nothing (NON); resuscitated pigs received additional infusions (5 mL/kg) at 30, 60, 120, or 180 min if hypotension or tachycardia persisted. Pigs were monitored for a 4-h "prehospital" period. At 4-h, hospital arrival was simulated: surgical sites were repaired, blood, or saline provided, and pigs were recovered from anesthesia. Pigs were monitored for 72 h and then killed for histological evaluation. One hundred percent (8/8) of HBOC-201-, 75% (6/8) of HEX-, and 25% (2/8) of NON-resuscitated pigs survived to 72 h (P = 0.007 overall, HBOC vs. HEX P > 0.05). Mean arterial pressure and mean pulmonary arterial pressure were highest in the HBOC-201 group (P < 0.001), and HR was lowest (P < 0.001). HBOC-201- and HEX-resuscitated pigs had comparable cardiac index and prehospital fluid requirements. HBOC-201 pigs had higher transcutaneous tissue oxygen tension, P < 0.001) and lower urine output (P < 0.001). At simulated hospital arrival, no HBOC-201 pigs required additional fluids or blood transfusion. In contrast, 100% of HEX pigs required blood transfusions (P < 0.01). In this swine model of controlled hemorrhage with low-volume resuscitation and delayed definitive care, HBOC-201 pigs had improved hemodynamics, transcutaneous tissue oxygen tension, and transfusion avoidance compared with HEX.
  • Authors

    Published In

  • Shock  Journal
  • Keywords

  • Animals, Blood Pressure, Blood Substitutes, Body Temperature, Cattle, Disease Models, Animal, Female, Fluid Therapy, Heart Rate, Hematocrit, Hemoglobins, Hydroxyethyl Starch Derivatives, Lactic Acid, Male, Oxygen Consumption, Polymers, Resuscitation, Shock, Hemorrhagic, Survival Analysis, Swine, Swine, Miniature, Urea
  • Digital Object Identifier (doi)

    Author List

  • Rice J; Philbin N; McGwin G; Arnaud F; Johnson T; Flournoy WS; Pearce LB; McCarron R; Kaplan L; Handrigan M
  • Start Page

  • 302
  • End Page

  • 310
  • Volume

  • 26
  • Issue

  • 3