TY - JOUR
T1 - Traumatic brain injury and severe uncontrolled haemorrhage with short delay pre-hospital resuscitation in a swine model
AU - Teranishi, Kohsuke
AU - Scultetus, Anke
AU - Haque, Ashraful
AU - Stern, Susan
AU - Philbin, Nora
AU - Rice, Jennifer
AU - Johnson, Todd
AU - Auker, Charles
AU - McCarron, Richard
AU - Freilich, Daniel
AU - Arnaud, Franoise
N1 - Funding Information:
This work was performed at Naval Medical Research Center, Silver Spring, MD and was supported by funding from DoD Work Unit No. 604771N.9737.001.A0315. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.
PY - 2012/5
Y1 - 2012/5
N2 - Introduction: Unavailability of blood (and oxygen delivery) for pre-hospital resuscitation in haemorrhagic shock patients are major problems, supporting the importance for novel resuscitation strategies. In a combined polytrauma model of uncontrolled haemorrhage and traumatic brain injury (TBI) in swine, we investigated if pre-hospital administration of the haemoglobin based oxygen carrier HBOC-201 will improve tissue oxygenation and physiologic parameters compared to Lactated Ringer's (LR) solution. Materials and methods: Anaesthetised Yorkshire swine underwent fluid-percussion TBI and Grade III liver laceration. During a 30-min pre-hospital phase, the animals were resuscitated with a single infusion of HBOC-201, LR solution, or nothing (NON). Upon hospital arrival, the animals were given blood or normal saline as needed. Surviving animals were euthanised 6 h post-injury. Cerebral blood flow was measured by microsphere injection, and pathology was assessed by gross observation and immunohistochemical analysis. Results: Mean TBI force (2.4 ± 0.1 atm) (means ± standard error of the mean) and blood loss (22.5 ± 1.7 mL/kg) were similar between groups. Survival at the 6 h endpoint was similar in all groups (∼50%). Cerebral perfusion pressure (CPP) and brain tissue oxygen tension were significantly greater in HBOC-201 as compared with LR animals (p < 0.005). Mean arterial pressure (MAP) and mean pulmonary artery pressure (MPAP) were not significantly different amongst groups. Blood transfusion requirements were delayed in HBOC-201 animals. Animals treated with HBOC-201 or LR showed no immunohistopathological differences in glial fibrillary acidic protein (GFAP) and microtubule-associated protein 2 (MAP-2). Severity of subarachnoid and intraparenchymal haemorrhages were similar for HBOC and LR groups. Conclusion: In this polytrauma swine model of uncontrolled haemorrhage and TBI with a 30-min delay to hospital arrival, pre-hospital resuscitation with one bolus of HBOC-201 indicated short term benefits in systemic and cerebrovascular physiological parameters. True clinical benefits of this strategy need to be confirmed on TBI and haemorrhagic shock patients.
AB - Introduction: Unavailability of blood (and oxygen delivery) for pre-hospital resuscitation in haemorrhagic shock patients are major problems, supporting the importance for novel resuscitation strategies. In a combined polytrauma model of uncontrolled haemorrhage and traumatic brain injury (TBI) in swine, we investigated if pre-hospital administration of the haemoglobin based oxygen carrier HBOC-201 will improve tissue oxygenation and physiologic parameters compared to Lactated Ringer's (LR) solution. Materials and methods: Anaesthetised Yorkshire swine underwent fluid-percussion TBI and Grade III liver laceration. During a 30-min pre-hospital phase, the animals were resuscitated with a single infusion of HBOC-201, LR solution, or nothing (NON). Upon hospital arrival, the animals were given blood or normal saline as needed. Surviving animals were euthanised 6 h post-injury. Cerebral blood flow was measured by microsphere injection, and pathology was assessed by gross observation and immunohistochemical analysis. Results: Mean TBI force (2.4 ± 0.1 atm) (means ± standard error of the mean) and blood loss (22.5 ± 1.7 mL/kg) were similar between groups. Survival at the 6 h endpoint was similar in all groups (∼50%). Cerebral perfusion pressure (CPP) and brain tissue oxygen tension were significantly greater in HBOC-201 as compared with LR animals (p < 0.005). Mean arterial pressure (MAP) and mean pulmonary artery pressure (MPAP) were not significantly different amongst groups. Blood transfusion requirements were delayed in HBOC-201 animals. Animals treated with HBOC-201 or LR showed no immunohistopathological differences in glial fibrillary acidic protein (GFAP) and microtubule-associated protein 2 (MAP-2). Severity of subarachnoid and intraparenchymal haemorrhages were similar for HBOC and LR groups. Conclusion: In this polytrauma swine model of uncontrolled haemorrhage and TBI with a 30-min delay to hospital arrival, pre-hospital resuscitation with one bolus of HBOC-201 indicated short term benefits in systemic and cerebrovascular physiological parameters. True clinical benefits of this strategy need to be confirmed on TBI and haemorrhagic shock patients.
KW - Haemoglobin-based oxygen carrier
KW - Haemorrhagic shock
KW - Polytrauma
KW - Resuscitation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=84859429353&partnerID=8YFLogxK
U2 - 10.1016/j.injury.2010.09.042
DO - 10.1016/j.injury.2010.09.042
M3 - Article
C2 - 21036354
AN - SCOPUS:84859429353
SN - 0020-1383
VL - 43
SP - 585
EP - 593
JO - Injury
JF - Injury
IS - 5
ER -