Improved outcome with early blood administration in a near-fatal model of porcine hemorrhagic shock

Dronen, Steven C.; Stern, Susan A.; Baldursson, Jón; Irvin, C. Warren; Syverud, Scott A.

doi:10.1016/0735-6757(92)90177-y

Cited by 18 publications

(7 citation statements)

References 18 publications

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“…The rats that received saline resuscitation developed a relative intracellular acidosis (control = 7.29 + 0.02, midHct = 7.25 ± 0.02, low-Hct = 7.23 ± 0.02; p < 0.05 controls vs. other groups by analysis of variance). At 24 hours, the death rates were significantly different among the groups: control = 1 of 36 rats (2.8%), mid-Hct = 6 of 39 (15.4%), and low-Hct = 14 of 60 (23.3%) (p < 0.05 by chi square analysis).…”

Section: Resultsmentioning

confidence: 99%

“…8). After resuscitation, the intracellular acid-base balance remained constant in the control group, whereas the mid-Hct and low-Hct groups had a progressive decline in intracellular pH (control = 24 Hrs. Survival Figure 6.…”

Section: Changes In Cellular Energeticsmentioning

confidence: 99%

“…This contention is supported by the recent work of other investigators who report the advantages of blood administration. 24 In the future, the availability of recombinant hemoglobin would circumvent current conAnn. Surg.…”

Section: Acid-base Statusmentioning

confidence: 99%

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Superiority of Blood Over Saline Resuscitation From Hemorrhagic Shock: A 31P Magnetic Resonance Spectroscopy Study

et al. 1997

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ObjectiveTo study the relation between blood and saline administration, postresuscitation hematocrit (Hct) level, and metabolic recovery after hemorrhagic shock. Summary Background DataIt is generally believed that crystalloid can be substituted, in whole or in part, for blood during resuscitation of hemorrhagic shock. This is based on the belief that Hct can be safely reduced but should not fall below a critical level. MethodsMale rats weighing 200 g were subjected to an isobaric hemorrhagic shock at a mean arterial pressure of 30 mmHg for 14 minutes, after which they were randomized to one of three resuscitation regimens. Control group (n = 36) were resuscitated by return of all shed blood. Mid-Hct (n = 39) and low-Hct (n = 60) groups were depleted of one third and one half of their circulating blood volumes, respectively, and were resuscitated with three times that volume of normal saline. Skeletal muscle intracellular energetics and pH were measured serially using 31p magnetic resonance spectroscopy at baseline, during shock, and after resuscitation. Arterial blood was sampled at the same time points. The number of surviving animals in each group at 24 hours was recorded. ResultsAfter resuscitation, surviving rats in the low-Hct group demonstrated a greater consumption of high-energy phosphocreatine stores than did the other groups (control = 0.479 ± 0.003, mid-Hct = 0.465 ± 0.004, low-Hct = 0.457 + 0.007, mean ± standard error of the mean; p < 0.01 low-Hct vs. other groups by analysis of variance). The rats that received saline resuscitation developed a relative intracellular acidosis (control = 7.29 + 0.02, midHct = 7.25 ± 0.02, low-Hct = 7.23 ± 0.02; p < 0.05 controls vs. other groups by analysis of variance). At 24 hours, the death rates were significantly different among the groups: control = 1 of 36 rats (2.8%), mid-Hct = 6 of 39 (15.4%), and low-Hct = 14 of 60 (23.3%) (p < 0.05 by chi square analysis). ConclusionThe oxygen-carrying capacity of resuscitation fluid has an important impact on intracellular metabolism and outcome.653

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Section: Resultsmentioning

confidence: 99%

Section: Changes In Cellular Energeticsmentioning

confidence: 99%

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Superiority of Blood Over Saline Resuscitation From Hemorrhagic Shock: A 31P Magnetic Resonance Spectroscopy Study

et al. 1997

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“…Meanwhile, the results from this and other studies suggested that blood transfusion after limited and, particularly, aggressive resuscitation in the prehospital phase has an important role in improving the outcome in uncontrolled hemorrhagic shock. Dronen et al (27) has proven that even brief delays in blood replacement may exacerbate the hemorrhagic shock and increase mortality. In a recent study, Zakaria et al (28) have suggested that resuscitation regimens for hemorrhagic shock must contain blood because blood-containing resuscitation regimens preserve and maintain hemodynamics and are associated with the least microvascular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Effect of Initial Fluid Resuscitation on Subsequent Treatment in Uncontrolled Hemorrhagic Shock in Rats

Nan

Wang²,

Diao³

et al. 2004

Shock

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Using a modified uncontrolled hemorrhage shock model with massive splenic and vascular injury, we evaluated outcome and tissue oxidation injury with different resuscitation interventions during prehospital and hospital phases. The aim of our study was to explore the effect of initial fluid resuscitation on subsequent treatment of uncontrolled hemorrhagic shock in rats. Uncontrolled hemorrhagic shock was produced in 114 Wistar rat by sharp transection both of the splenic parenchyma at one location between the major branches of the splenic artery into the spleen and of one of the major branches of the splenic artery. Experimental design consisted of three phases: a "prehospital phase" (resuscitation with balanced saline to a mean arterial pressure (MAP) of 40, 50, 60, 80, and 100 mmHg, respectively, when MAP reached 30 mmHg), followed by a "hospital phase" (120 min, including control of hemorrhage and resuscitation with balanced saline and whole blood (2:1) or balanced saline alone to a MAP >80 mmHg), and a 240-min observation phase. Blood loss, infused volume, hematocrit, and survival rate were recorded. At the end of the experiment, survivors were sacrificed, and the lung, kidney, and distal ileum were harvested for determination of malondialdehyde (MDA) content and total antioxidative capacity (T-AOC). All rats that were resuscitated to a MAP >80 mmHg in the prehospital phase and received balanced saline alone in the hospital phase died, whereas those that had been resuscitated to a MAP of 40 or 50 mmHg during the prehospital phase and then resuscitated with balanced saline and whole blood in the hospital phase survived throughout the experiment. The animals whose MAP was kept higher than 80 mmHg had significantly higher MDA content and lower T-AOC than those whose MAP was maintained 40, 50, or 60 mmHg during the prehospital phase. In the hospital phase, resuscitation with balanced saline and whole blood not only relieved tissue damage but also improved the survival, as indicated by 44.4% survival rate in the rats that resuscitated to a MAP of 80 or 100 mmHg in the prehospital phase. These results suggested that in our uncontrolled hemorrhagic shock model, limited resuscitation in the prehospital phase had benefit for subsequent treatment in the hospital phase in terms of alleviated tissue damage and improved survivorship.

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“…Dronen et al 10 studying young pigs, emphasized the importance of reaching a goal that could express the degree of physiologic insult just as respiratory arrest or cardiac arrhythmia. However, in our experience, this goal, although associated to the death of the animal when not treated, not always it is associated by significant lactic acidosis.…”

Section: ■ Discussionmentioning

confidence: 99%

A fatal and metabolic experimental hemorrhagic shock in immature swine

et al. 2017

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Improved outcome with early blood administration in a near-fatal model of porcine hemorrhagic shock

Cited by 18 publications

References 18 publications

Superiority of Blood Over Saline Resuscitation From Hemorrhagic Shock: A 31P Magnetic Resonance Spectroscopy Study

Superiority of Blood Over Saline Resuscitation From Hemorrhagic Shock: A 31P Magnetic Resonance Spectroscopy Study

Effect of Initial Fluid Resuscitation on Subsequent Treatment in Uncontrolled Hemorrhagic Shock in Rats

A fatal and metabolic experimental hemorrhagic shock in immature swine

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