Resuscitation from severe hemorrhage

Shoemaker, William C.; Peitzman, Andrew B.; Bellamy, Ronald F.; Bellomo, Rinaldo; Bruttig, Stephen P.; Capone, Antonio; Dubick, Michael A.; Kramer, George C.; McKenzie, Jack E.; Pepe, Paul E.; Šafář, Peter; Schlichtig, Robert; Severinghaus, John W.; Tisherman, Samuel A.; Wiklund, Lars

doi:10.1097/00003246-199602000-00045

Cited by 134 publications

(72 citation statements)

References 42 publications

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“…27 Results showed that ITPR-CPR is beneficial in this setting also, when circulatory volume depends heavily on venous return. The most important finding from this protocol was that the ITPR significantly increased coronary and cerebral perfusion pressures by Ͼ50% compared with controls.…”

Section: Discussionmentioning

confidence: 96%

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

et al. 2005

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Background-A novel device, the intrathoracic pressure regulator (ITPR), combines an inspiratory impedance threshold device (ITD) with a vacuum source for the generation of controlled Ϫ10 mm Hg vacuum in the trachea during cardiopulmonary resuscitation (CPR) while allowing positive pressure ventilation. Compared with standard (STD) CPR, ITPR-CPR will enhance venous return, systemic arterial pressure, and vital organ perfusion in both porcine models of ventricular fibrillation and hypovolemic cardiac arrest. Methods and Results-In protocol 1, 20 pigs (weight, 30Ϯ0.5 kg) were randomized to STD-CPR or ITPR-CPR. After 8 minutes of untreated ventricular fibrillation, CPR was performed for 6 minutes at 100 compressions per minute and positive pressure ventilation (100% O 2 ) with a compression-to-ventilation ratio of 15:2. In protocol 2, 6 animals were bled 50% of their blood volume. After 4 minutes of untreated ventricular fibrillation, interventions were performed for 2 minutes with STD-CPR and 2 minutes of ITPR-CPR. This sequence was repeated. In protocol 3, 6 animals after 8 minutes of untreated VF were treated with ITPR-CPR for 15 minutes, and arterial and venous blood gases were collected at baseline and minutes 5, 10, and 15 of CPR. A newer, leak-proof ITPR device was used. Aortic, right atrial, endotracheal pressure, intracranial pressure, and end-tidal CO 2 values were measured (mm Hg); common carotid arterial flow also was measured (mL/min). Coronary perfusion pressure (diastolic; aortic minus right atrial pressure) and cerebral perfusion pressure (mean arterial minus mean intracranial pressure) were calculated. Unpaired Student t test and Friedman's repeated-measures ANOVA of ranks were used in protocols 1 and 3. A 2-tailed Wilcoxon signed-rank test was used for analysis in protocol 2. Fischer's exact test was used for survival. Significance was set at PϽ0.05. Vital organ perfusion pressures and end-tidal CO 2 were significantly improved with ITPR-CPR in both protocols. In protocol 1, 1-hour survival was 100% with ITPR-CPR and 10% with STD-CPR (Pϭ0.001). Arterial blood pH was significantly lower and PaCO 2 was significantly higher with ITPR-CPR in protocol 1. Arterial oxygen saturation was 100% throughout the study in both protocols. PaCO 2 and PaO 2 remained stable, but metabolic acidosis progressed, as expected, throughout the 15 minutes of CPR in protocol 3. Conclusions-Compared

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Section: Discussionmentioning

confidence: 96%

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

et al. 2005

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“…6,28 Early identification of impending tissue hypoxia accompanied by rapid intervention constitutes the most effective way in which to prevent organ failure. 29,30 Presently, the recommended strategy for identifying hypovolemic shock is to assess the clinical signs and symptoms, central blood volume, cardiac output, arterial blood chemistry, and systemic blood pressure. 3,31 Pulmonary wedge pressure ͑PWP͒ has been shown to be a sensitive and accurate indicator of central blood volume; 32 low PWP means that the preload volume is insufficient to maintain adequate cardiac output.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive monitoring of hemodynamic stress using quantitative near-infrared frequency-domain photon migration spectroscopy

Pham

Hornung

et al. 2002

J. Biomed. Opt.

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Abstract. Hemorrhagic hypovolemia and inotropic agent administration were used to manipulate cardiac output (CO) and oxygen delivery in rabbits to investigate the correlation between noninvasive frequency domain photon migration (FDPM) spectroscopy and invasive hemodynamic monitoring parameters. Frequency-domain photon migration provides quantitative measurements of light absorption and reduced scattering ( a and s Ј , respectively) in tissue. Wavelength dependent a values were used to calculate in vivo tissue concentration of deoxyhemoglobin [Hb], oxyhemoglobin ͓HbO 2 ͔, total hemoglobin [TotHb], and water ͓H 2 O͔ as well as mixed arterial-venous oxygen saturation (S t O 2 ) in tissue. FDPM-derived physiologic properties were correlated with invasive measurements of CO and mean pulmonary artery pressure (mPAP), FDPM-derived [TotHb] and S t O 2 correlated significantly with hemorrhaged volume (HV), mPAP, and CO. Correlation coefficients for [TotHb] vs HV, mPAP, and CO were −0.77, 0.86, and 0.70, respectively. Correlation coefficients of S t O 2 vs HV, mPAP, and CO were −0.71, 0.55, and 0.61, respectively. Dobutamine induced changes resulted in correlation coefficients between FDPM-derived and invasively measured physiologic parameters that are comparable to those induced by hypovolemia. FDPM spectroscopy is sensitive to changes in mPAP and CO of as little as 15%. These results suggest that FDPM spectroscopy may be used in clinical settings to noninvasively monitor central hemodynamic parameters and to directly assess oxygenation of tissues.

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“…An abundance of data from well constructed laboratory studies in a variety of small and large mammals has shown that survival from uncontrolled haemorrhagic shock is enhanced by fluid resuscitation limited to that required to maintain mean arterial pressure (MAP) at 50-60 mmHg (70-80 per cent of normal) 17 . Optimal oxygen delivery is achieved when some fluids are provided, but without attempting to normalize MAP.…”

Section: Management Of Blood Pressurementioning

confidence: 99%

“…Animal models have been constructed that precisely delineate the boundaries of fatal hypoperfusion (about 2 h at a MAP of 40 mmHg) and fatal rebleeding (any MAP greater than 80 per cent of normal) 19 . Published studies almost universally demonstrate reduced total blood loss and improved survival when the haemorrhaging animal is maintained within these limits 17,19 . Limitations of the bench science literature include the use of blood pressure as a surrogate for tissue perfusion, and the less obvious effects of general anaesthesia required by the protocols used.…”

Section: Management Of Blood Pressurementioning

confidence: 99%

Resuscitative strategies to maintain homeostasis during damage control surgery

Dutton

2011

British Journal of Surgery

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Background: Successful outcome from damage control surgery (DCS) depends as much on elements of resuscitation and non-operative management as on details of the procedure itself. The early management of patients in haemorrhagic shock has undergone substantial revision in the past decade and is now known as 'haemostatic resuscitation'.Methods: An updated literature review describing the anaesthetic and resuscitative management of patients with active, ongoing traumatic haemorrhage was distilled to present the current knowledge of the pathophysiology, recommended treatments and areas of active controversy.Results: Current practice in military and civilian trauma centres is described, along with the degree of evidence in support of clinical decisions. Resuscitation of patients with ongoing traumatic haemorrhage has changed substantially in the past two decades. Optimal management now includes deliberate hypotension to minimize blood loss, early use of blood products (especially plasma) and administration of antifibrinolytic therapy. Areas of debate include the role of clotting factor concentrates and depth of anaesthesia. Conclusion: Resuscitation strategies during DCS may be as important as the anatomical repair itself.Recommendations include avoidance of hypothermia, maintenance of a lower than normal blood pressure, and early support of the coagulation system in patients likely to require massive transfusion. Controversies include the optimal ratio of plasma to red blood cells for empirical resuscitation, the ideal role of clotting factor concentrates, and the potential benefit of early, deep anaesthesia. Future research will centre on the complex interaction between the humoral elements of coagulation and the vascular endothelium that regulates perfusion, clotting and integrity of the circulation.

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Resuscitation from severe hemorrhage

Cited by 134 publications

References 42 publications

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

Noninvasive monitoring of hemodynamic stress using quantitative near-infrared frequency-domain photon migration spectroscopy

Resuscitative strategies to maintain homeostasis during damage control surgery

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