DCL-Hb for trauma patients with severe hemorrhagic shock: the European "On-Scene" Multicenter Study

Kerner, Thoralf; Ahlers, Olaf; Veit, S; Riou, Bruno; Saunders, M.; Pison, U.

doi:10.1007/s00134-002-1622-x

Cited by 71 publications

(55 citation statements)

References 24 publications

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“…Moreover, in randomized clinical trials, a more liberal RBC transfusion strategy failed to benefit pediatric or adult patients with anemia and critical illness (11,12), raising the broader concern that RBC storage is problematic (2,13) and could be improved. This is particularly relevant because, to date, the development of and outcomes with blood substitutes have been disappointing (14)(15)(16).…”

mentioning

confidence: 99%

Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

543

556

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Recent studies have underscored questions about the balance of risk and benefit of RBC transfusion. A better understanding of the nature and timing of molecular and functional changes in stored RBCs may provide strategies to improve the balance of benefit and risk of RBC transfusion. We analyzed changes occurring during RBC storage focusing on RBC deformability, RBC-dependent vasoregulatory function, and S-nitrosohemoglobin (SNO-Hb), through which hemoglobin (Hb) O2 desaturation is coupled to regional increases in blood flow in vivo (hypoxic vasodilation). Five hundred ml of blood from each of 15 healthy volunteers was processed into leukofiltered, additive solution 3-exposed RBCs and stored at 1-6°C according to AABB standards. Blood was subjected to 26 assays at 0, 3, 8, 24 and 96 h, and at 1, 2, 3, 4, and 6 weeks. RBC SNO-Hb decreased rapidly (1.2 ؋ 10 ؊4 at 3 h vs. 6.5 ؋ 10 ؊4 (fresh) mol S-nitrosothiol (SNO)/mol Hb tetramer (P ‫؍‬ 0.032, mercuric-displaced photolysis-chemiluminescence assay), and remained low over the 42-day period. The decline was corroborated by using the carbon monoxide-saturated copper-cysteine assay [3.0 ؋ 10 ؊5 at 3 h vs. 9.0 ؋ 10 ؊5 (fresh) mol SNO/mol Hb]. In parallel, vasodilation by stored RBCs was significantly depressed. RBC deformability assayed at a physiological shear stress decreased gradually over the 42-day period (P < 0.001). Time courses vary for several storage-induced defects that might account for recent observations linking blood transfusion with adverse outcomes. Of clinical concern is that SNO levels, and their physiological correlate, RBC-dependent vasodilation, become depressed soon after collection, suggesting that even ''fresh'' blood may have developed adverse biological characteristics.adenosine triphosphate ͉ hemoglobin ͉ nitric oxide ͉ S-nitrosothiols ͉ transfusion

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mentioning

confidence: 99%

Evolution of adverse changes in stored RBCs

Bennett‐Guerrero¹,

Veldman²,

Doctor

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

543

556

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“…In 2003, a randomized controlled study was performed by Kerner et al [ 29 ] in trauma patients with hypovolemic shock. The study population was sorted into the standard care group ( n = 62) or into the HemAssist ® group (1,000 mL) ( n = 53) during transport from the scene of trauma to the hospital and until defi nitive control of bleeding source.…”

Section: Diaspirin Cross-linked Hemoglobinmentioning

confidence: 99%

Diaspirin Cross-Linked Hemoglobin and Blood Substitutes

Romagnoli

Zagli

Ricci

2015

Reducing Mortality in Critically Ill Patients

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Oxygen delivery (DO 2 ) to organs and tissues depends on fl ow generated by the heart (cardiac output, CO) and arterial oxygen content. Arterial oxygen content depends on oxygen partial pressure (PaO 2 ) and hemoglobin (Hb) concentration and saturation. In case of hypoxemia and/or low CO states, Hb concentration may play a key role in preventing tissue hypoxia and cellular dysfunction.Although Hb concentration in perioperative settings and in critical care is a crucial aspect for almost all patients, the optimal values are still a matter of debate [ 1 ]. Nonetheless, current guidelines and recommendations suggest lower "transfusion triggers" than in the past, encouraging blood-saving techniques following a multidisciplinary, multi-procedural approach [ 2 ]. The diffi culties of supplying red blood cells (RBCs), the need to overcome problems of storage and transfusion (refrigeration and crossmatching), the aim to avoid potential transfusions' harming effects (infection, transfusion reactions, transfusion-related acute lung injury, immunomodulation) [ 3 , 4 ], and the need for alternatives to biological blood for religious reasons (e.g., Jehovah's Witnesses) [ 5 , 6 ] have led scientists and companies, over the past three decades, to synthesize and test artifi cial blood solutions. Oxygen carrier (OC) is a generic defi nition for blood substitutes, blood surrogates, artifi cial Hb, or artifi cial blood. These substances mimic oxygen-carrying function of the RBCs (Table 11.1 ) and are characterized by a long shelf life. In other words, OCs are pharmacological substances that aim to improve DO 2 independently from RBCs.

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“…Finally, this was a poorly designed trial that had problems with randomization and end points. Baxter conducted a companion phase III trauma trial in Europe using morbidity, rather than mortality, as the efficacy end point (112). Another important difference with the U.S. trauma trial was that in the European study, the patients were randomized "on scene" to receive DCLHb or standard fluid therapy.…”

Section: Human Studies and Possible Indicationsmentioning

confidence: 99%

Hemoglobin solutions

Créteur¹,

Vincent²

2003

Critical Care Medicine

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Today, we are aware of the effects of the first generation of blood substitutes. Further research is ongoing into newer solutions. One area of interest is the development of new molecular structures to decrease nitric oxide binding, thus minimizing any adverse events and maximizing potential benefits. Nevertheless, possible adverse effects need to be carefully evaluated before these agents can be widely administered.

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DCL-Hb for trauma patients with severe hemorrhagic shock: the European "On-Scene" Multicenter Study

Cited by 71 publications

References 24 publications

Evolution of adverse changes in stored RBCs

Evolution of adverse changes in stored RBCs

Diaspirin Cross-Linked Hemoglobin and Blood Substitutes

Hemoglobin solutions

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