TY - JOUR
T1 - Resuscitation following severe, controlled hemorrhage associated with a 24 h delay to surgical intervention in swine using a hemoglobin based oxygen carrier as an oxygen bridge to definitive care
AU - Philbin, Nora
AU - Handrigan, Michael
AU - Rice, Jennifer
AU - McNickle, Kyle
AU - McGwin, Gerald
AU - Williams, Rita
AU - Warndorf, Mathew
AU - Arnaud, Françoise
AU - Malkevich, Nina
AU - McCarron, Richard
AU - Freilich, Daniel
N1 - Funding Information:
The studies described herein were entirely funded by the U.S. Government (Office of Naval Research Work Unit Number 602236N.4426.W26.A0241). Test materials were provided free of charge under a Materials Transfer Agreement by Biopure Corp. (HBOC-201) and Abbott Laboratories, Chicago, IL (HEX). The Naval Medical Research Center authors have no financial or other competing interests related to this article. Dr. G. McGwin has no financial or competing interests. The opinions expressed in this paper are those of the authors and do not reflect the official policy of the Departments of the Navy, Army, and Defense, or the U.S. Government.
PY - 2007/8
Y1 - 2007/8
N2 - Objectives: To test our hypothesis that the hemoglobin based oxygen carrier HBOC-201 would have similar or superior efficacy to 6% hetastarch (HEX) as a pre-hospital 'bridging' fluid for hemorrhagic shock when delay to definitive medical care is prolonged to 24 h. Methods: Twenty-four pigs were anesthetized, instrumented, given a soft tissue injury, and bled 55% estimated blood volume. Pigs were randomized to receive HBOC-201, HEX, or no resuscitation fluids (NON). At 4 h post-injury, surgical sites were repaired and pigs were recovered from anesthesia. Animals were non-invasively monitored, administered blood for anemia or saline for hypotension at 24 and 48 h, and monitored for 72 h. Results: Survival to 72 h was 87.5% (7/8) in HBOC-201 and HEX pigs compared to 25% (2/8) in NON pigs (p = 0.01). Increased mean arterial pressure was observed in the HBOC-201 group (p < 0.0001). Cardiac index was highest in HEX pigs (overall p < 0.001, HBOC-201 versus HEX p = 0.002). Transcutaneous tissue oxygenation was higher with HBOC-201 (overall p = 0.04, HBOC-201 versus HEX p < 0.01). HBOC-201 and HEX pigs had comparable heart rates, pulmonary pressures, pre-hospital fluid requirements, venous O2 saturation, base deficit, and lactic acid. Hemoglobin was decreased with HEX (overall p < 0.0001, HBOC-201 versus HEX p < 0.0002). At 24 h, 14.3% (1/7) HBOC-201 pigs required blood transfusions versus 100% HEX (7/7) and NON (2/2) pigs (p > 0.001). Conclusions: HBOC-201 restored hemodynamics, maintained tissue oxygenation, and decreased blood transfusions in comparison to HEX in severe controlled HS with 24 h delay to simulated hospital care. These results support the potential use of HBOC-201 as a bridging resuscitation fluid for HS.
AB - Objectives: To test our hypothesis that the hemoglobin based oxygen carrier HBOC-201 would have similar or superior efficacy to 6% hetastarch (HEX) as a pre-hospital 'bridging' fluid for hemorrhagic shock when delay to definitive medical care is prolonged to 24 h. Methods: Twenty-four pigs were anesthetized, instrumented, given a soft tissue injury, and bled 55% estimated blood volume. Pigs were randomized to receive HBOC-201, HEX, or no resuscitation fluids (NON). At 4 h post-injury, surgical sites were repaired and pigs were recovered from anesthesia. Animals were non-invasively monitored, administered blood for anemia or saline for hypotension at 24 and 48 h, and monitored for 72 h. Results: Survival to 72 h was 87.5% (7/8) in HBOC-201 and HEX pigs compared to 25% (2/8) in NON pigs (p = 0.01). Increased mean arterial pressure was observed in the HBOC-201 group (p < 0.0001). Cardiac index was highest in HEX pigs (overall p < 0.001, HBOC-201 versus HEX p = 0.002). Transcutaneous tissue oxygenation was higher with HBOC-201 (overall p = 0.04, HBOC-201 versus HEX p < 0.01). HBOC-201 and HEX pigs had comparable heart rates, pulmonary pressures, pre-hospital fluid requirements, venous O2 saturation, base deficit, and lactic acid. Hemoglobin was decreased with HEX (overall p < 0.0001, HBOC-201 versus HEX p < 0.0002). At 24 h, 14.3% (1/7) HBOC-201 pigs required blood transfusions versus 100% HEX (7/7) and NON (2/2) pigs (p > 0.001). Conclusions: HBOC-201 restored hemodynamics, maintained tissue oxygenation, and decreased blood transfusions in comparison to HEX in severe controlled HS with 24 h delay to simulated hospital care. These results support the potential use of HBOC-201 as a bridging resuscitation fluid for HS.
KW - HBOC-201
KW - Hemorrhage
KW - Hypovolemic shock
KW - Resuscitation
KW - Swine
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=34347387730&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2006.12.018
DO - 10.1016/j.resuscitation.2006.12.018
M3 - Article
C2 - 17383073
AN - SCOPUS:34347387730
SN - 0300-9572
VL - 74
SP - 332
EP - 343
JO - Resuscitation
JF - Resuscitation
IS - 2
ER -