“Blood failure” time to view blood as an organ: how oxygen debt contributes to blood failure and its implications for remote damage control resuscitation

Abstract

Hemorrhagic shock is both a local and systemic disorder. In the context of systemic effects, blood loss may lead to levels of reduced oxygen delivery (DO2) sufficient to cause tissue ischemia. Similar to other physiologic debts such as sleep, it is not possible to incur a significant oxygen debt and suffer no consequences for lack of timely repayment. While the linkage between oxygen debt and traditional organ failure (renal, hepatic, lung, and circulation) has been long recognized, we should consider failure in two additional linked and very dynamic organ systems, the endothelium and blood. These systems are very sensitive to oxygen debt and at risk for failing, having further implications on all other organ systems. The degree of damage to the endothelium is largely modulated by the degree of oxygen debt. Thus hypoperfusion is believed to begin a cascade of events leading to acute traumatic coagulopathy (ATC). This combination of oxygen debt driven endothelial damage and ATC might be considered collectively as “blood failure” due to the highly connected networks between these drivers. This article presents the implications of oxygen debt for remote damage control resuscitation strategies, such as permissive hypotension and hemostatic resuscitation. We review the impact of whole blood resuscitation and red blood cell efficacy in mitigation of oxygen debt. At last, this article recognizes the need for simple and durable, lightweight equipment that can detect the adequacy of tissue DO2 and thus patient needs for resuscitative care. Point‐of‐care lactate measuring may be a predictive tool for identifying high‐risk trauma patients and occult shock because it provides information beyond that of vital signs and mechanism of injury as it may help predict the level of oxygen debt accumulation and need for resuscitation. Serial measurements may also be valuable as a tool in guiding resuscitative efforts.

Whole blood for hemostatic resuscitation of major bleeding

“…Mitigation of oxygen debt accumulation not only prevents adverse effects of hypoxia, but also prevents the exacerbation of coagulopathy . WB meets this need since it has a 30% higher oxygen‐carrying capacity than components in 1:1:1 ratio . The quality of the RBCs, plasma, and PLTs provided for patients in hemorrhagic shock is also important.…”

Granulocyte-Colony Stimulating Factor (G-CSF) Accelerates Wound Healing in Hemorrhagic Shock Rats by Enhancing Angiogenesis and Attenuating Apoptosis

“…Although combined injuries like hemorrhagic shock combined with cutaneous injury often occur in traffic accidents and war, little is known about wounds affected by blood loss and the wound repair process. The restriction of blood supply to skin after blood loss leads to tissue hypoxia and even tissue necrosis [5–7]. Severe blood supply inefficiency and tissue apoptosis hinder wound repair because of endothelial cell (ECs) dysfunction in injured tissues [8].…”

Rotational thromboelastometry (ROTEM) parameters in dogs with haemoperitoneum and their associations with clinical and laboratory signs

“…This indicates that hypoperfusion in patients with haemoperitoneum may be one of the causes of CT and CFT prolongation. The endothelium is very sensitive to ischemia 4 and reacts to it by upregulating thrombomodulin expression and increasing thrombin generation. 13 Thus, hypoperfusion is believed to start a cascade of events leading to various changes in haemostasis.…”