Is limited prehospital resuscitation with plasma more beneficial than using a synthetic colloid? An experimental study in rabbits with parenchymal bleeding

Kheirabadi, Bijan S.; Valdez-Delgado, Krystal K; Terrazas, Irasema B; Miranda, Nahir; Dubick, Michael A.

doi:10.1097/ta.0000000000000591

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…Availability of blood products is a critical priority in remote damage control resuscitation, but because of the difficulties in maintaining frozen product, plasma is not often used outside hospital settings . When crystalloid or colloid substitutes are used in resuscitation, perfusion and pressure may be normalized at the expense of endothelial damage and coagulopathy .…”

Section: Discussionmentioning

confidence: 99%

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Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties

Meledeo

Liu²,

Peltier

et al. 2018

Transfusion

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BACKGROUND: Dried plasmas can overcome logistical barriers that prevent fresh frozen plasma (FFP) usage in acute resuscitation, but processing of these products can detrimentally alter the composition. Spraydried plasma (SpDP) from single units is deficient in high-molecular-weight multimers of von Willebrand factor (vWF), a critical facilitator of platelet adhesion and thrombus formation. We hypothesized that converting high-molecular-weight multimers to smaller-molecularweight multimers would retain vWF's capacity to mediate platelet adhesion.STUDY DESIGN AND METHODS: SpDP obtained from untreated FFP was reconstituted with glycinehydrochloric acid (HCl) and glycine (20 mM:50 mM) or pretreated with glycine-HCl (20 mM) or glycine-glycine-HCl (20 mM:50 mM) and reconstituted with water. In vitro hemostatic potential of SpDPs versus FFP or FFP spiked with 70 mM of glycine was evaluated, leading to a more detailed in vitro study of glycine-HCl-glycine (20 mM:50 mM) pretreated SpDP. Plasmas were combined with RBCs and platelets to observe global coagulation response. RESULTS:While vWF-ristocetin cofactor activity is significantly decreased (−41.13%; p < .0001) in SpDP, a model of vWF-mediated platelet adhesion to collagen under flow showed enhanced function (+13%; p < .01). Fewer microparticles, particularly of platelet origin, were observed in SpDP versus FFP (p < .0001). Small but significant differences in thromboelastography results were observed, although SpDP and FFP were within normal ranges. CONCLUSION: Comparable coagulability wasobserved in FFP and SpDP. The apparent paradox between vWF-ristocetin cofactor assay and vWF-mediated platelet adhesion may be explained by the increase in smaller multimers of vWF in SpDP, producing different outcomes in these assays.

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Section: Discussionmentioning

confidence: 99%

“…It has been repeatedly demonstrated since World War I that blood products are superior to crystalloid and colloid resuscitation solutions for transfusion treatment of hemorrhagic shock and restoration of hemostasis . Patients with severe trauma and bleeding need hemorrhage control, transfusion, and surgery as quickly as possible.…”

mentioning

confidence: 99%

Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties

Meledeo

Liu²,

Peltier

et al. 2018

Transfusion

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“…While loss of circulating albumin correlated with loss of the glycocalyx and increased fluid extravasation ( 96 ), albumin supplementation attenuated glycocalyx shedding and reduced interstitial edema in a guinea pig heart model of cold ischemia ( 97 ). Kheirabadi et al ( 98 ) studied the role of albumin in a model of uncontrolled hemorrhage. Rabbits were subjected to a splenic injury.…”

Section: Endothelial Glycocalyxmentioning

confidence: 99%

The Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?

Barelli

Alberio

2018

Front. Med.

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Massive hemorrhage is a leading cause of death worldwide. During the last decade several retrospective and some prospective clinical studies have suggested a beneficial effect of early plasma-based resuscitation on survival in trauma patients. The underlying mechanisms are unknown but appear to involve the ability of plasma to preserve the endothelial glycocalyx. In this mini-review, we summarize current knowledge on glycocalyx structure and function, and present data describing the impact of hemorrhagic shock and resuscitation fluids on glycocalyx. Animal studies show that hemorrhagic shock leads to glycocalyx shedding, endothelial inflammatory changes, and vascular hyper-permeability. In these animal models, plasma administration preserves glycocalyx integrity and functions better than resuscitation with crystalloids or colloids. In addition, we briefly present data on the possible plasma components responsible for these effects. The endothelial glycocalyx is increasingly recognized as a critical component for the physiological vasculo-endothelial function, which is destroyed in hemorrhagic shock. Interventions for preserving an intact glycocalyx shall improve survival of trauma patients.

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“…Although the endothelium of the IO space can accommodate a five-fold increase in volume, the noncompliant bony cortex limits expansion 5 . The marrow compartments of various IO infusion sites possess different ratios of red to yellow bone marrow, with variable vascularity, which may impact the rate of 5% albumin infusion 16 . No studies have determined whether the IO administration of 5% albumin differs from IV administration relative to infusion time and the effects on hemodynamic measurements in a hemorrhage model.…”

Section: Introductionmentioning

confidence: 99%

“…Further, the survival rate for animals receiving 5% albumin was 89% compared to 40% in animals receiving plasma or Hextend. 15 These studies suggest 5% albumin may be an attractive option for treating hemorrhagic shock with the benefits of increasing survival without adversely affecting coagulation. However, neither of these studies compared the IO to the IV route of administration.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock

Muir

Sheppard

Maika-Wilson

et al. 2016

Prehosp. Disaster med.

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While significantly longer to infuse 5% albumin by the TIO route, the longer TIO infusion time may be negated as IO devices can be placed more quickly compared to repeated IV attempts. The lack of significant difference between the TIO and IV routes relative to hemodynamic measures indicate the TIO route is a viable route for the infusion of 5% albumin in a swine model of Class III hemorrhage. Muir SL , Sheppard LB , Maika-Wilson A , Burgert JM , Garcia-Blanco J , Johnson AD , Coyner JL . A comparison of the effects of intraosseous and intravenous 5% albumin on infusion time and hemodynamic measures in a swine model of hemorrhagic shock. Prehosp Disaster Med. 2016;31(4):436-442.

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Is limited prehospital resuscitation with plasma more beneficial than using a synthetic colloid? An experimental study in rabbits with parenchymal bleeding

Abstract: Resuscitation with plasma or albumin better preserved coagulation function than did Hextend. However, despite these improvements, plasma resuscitation did not reduce blood loss or improve survival, while albumin administration seemed beneficial.

Cited by 10 publications

References 21 publications

Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties

Spray‐dried plasma deficient in high‐molecular‐weight multimers of von Willebrand factor retains hemostatic properties

The Role of Plasma Transfusion in Massive Bleeding: Protecting the Endothelial Glycocalyx?

A Comparison of the Effects of Intraosseous and Intravenous 5% Albumin on Infusion Time and Hemodynamic Measures in a Swine Model of Hemorrhagic Shock

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