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

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: Jennifer Rice, Nora Philbin, Gerald McGwin, Françoise Arnaud, Todd Johnson, W Shannon Flournoy, L Bruce Pearce, Richard McCarron, Lew Kaplan, Michael Handrigan, Daniel Freilich
• Journal: Shock (Augusta, Ga.) (Shock) Vol. 26 Issue 3 Pg. 302-10 (Sep 2006) ISSN: 1073-2322 [Print] United States
• PMID: 16912657 (Publication Type: Comparative Study, Journal Article, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Blood Substitutes
• Hemoglobins
• Hydroxyethyl Starch Derivatives
• Polymers
• polymerized bovine hemoglobin
• HBOC 201
• Lactic Acid
• Urea

Topics

• Animals
• Blood Pressure (physiology)
• Blood Substitutes (therapeutic use)
• Body Temperature
• Cattle
• Disease Models, Animal
• Female
• Fluid Therapy (methods)
• Heart Rate (physiology)
• Hematocrit
• Hemoglobins (analysis, therapeutic use)
• Hydroxyethyl Starch Derivatives (therapeutic use)
• Lactic Acid (blood)
• Male
• Oxygen Consumption (physiology)
• Polymers (therapeutic use)
• Resuscitation
• Shock, Hemorrhagic (physiopathology, therapy)
• Survival Analysis
• Swine
• Swine, Miniature
• Urea (urine)