Coagulation patterns following haemoglobin-based oxygen carrier resuscitation in severe uncontrolled haemorrhagic shock in swine

F. Arnaud*, M. Handrigan, M. Hammett, N. Philbin, J. Rice, F. Dong, L. B. Pearce, R. McCarron, D. Freilich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Massive blood loss due to penetrating trauma and internal organ damage can cause severe haemorrhagic shock (HS), leading to a severely compromised haemostatic balance. This study evaluated the effect of bovine polymerized haemoglobin (Hb) (Hb-based oxygen carrier, HBOC) resuscitation on haemostasis in a swine model of uncontrolled HS. Following liver injury/HS, swine received HBOC (n = 8), Hextend (HEX) (n = 8) or no resuscitation (NON) (n = 8). Fluids were infused to increase mean arterial pressure above 60 mmHg and to reduce heart rate to baseline. At 4 h, the animals were eligible for blood transfusions. Prothrombin time (PT), activated partial thromboplastin time, fibrinogen, thromboelastography (TEG) and platelet function analyser closure time (PFA-CT) were compared by using mixed statistical model. At 4 h, blood loss (% estimated blood volume) was comparable for HBOC (65.5 ± 18.5%) and HEX (80.8 ± 14.4%) and less for NON (58.7 ± 10.1%; P < 0.05). Resuscitation-induced dilutional coagulopathy was observed with HBOC and HEX, as indicated by reduced haematocrit, platelets and fibrinogen (P < 0.05). At 4 h, PT was higher in HEX than in HBOC groups (P < 0.01). In the early hospital phase, a trend to increased TEG reaction time and PFA-CT indicates that dilutional effects persist in HBOC and HEX groups. PFA-CT returned to baseline later with HBOC than with HEX (48 vs. 24 h) following blood transfusion. At 4 h, all surviving HEX animals (n = 3) required transfusion, in contrast to no HBOC (n = 7) or NON (n = 1) animals. In this severe uncontrolled HS model, successful resuscitation with HBOC produced haemodilutional coagulopathy less than or similar to that produced by resuscitation with HEX.

Original languageEnglish
Pages (from-to)290-302
Number of pages13
JournalTransfusion Medicine
Issue number4
StatePublished - Aug 2006
Externally publishedYes


  • Haemostasis
  • Oxygen carriers
  • Resuscitation
  • Swine model
  • Transfusion
  • Trauma


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