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Hypotensive resuscitation using a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) leads to reversal of anaerobic metabolism.
J Trauma. 2001 Jun; 50(6):1063-75.JT

Abstract

BACKGROUND

Traditional resuscitation regimens have been recently challenged. This study evaluates hypotensive resuscitation with a hemoglobin-based oxygen-carrying (HBOC) solution after severe hemorrhage in a porcine model. We hypothesized that HBOC-201 restores tissue perfusion at a lower mean arterial pressure than standard resuscitation fluids.

METHODS

Yorkshire swine (55-65 kg, n = 30), were rapidly hemorrhaged to a mean arterial pressure (MAP) of 30 mm Hg, maintained hypotensive for 45 minutes, and randomized into groups. Group I was resuscitated with an HBOC solution to a MAP of 60 mm Hg. Groups II and III were resuscitated to a MAP of 80 mm Hg with lactated Ringer's solution (LR) alone or LR (40 mL/kg) followed by shed blood, respectively. Group IV was resuscitated with shed blood alone to a MAP of 60 mm Hg. Group V received an HBOC solution to a MAP of 50 mm Hg. Hemodynamic variables, Swan-Ganz parameters, blood gas samples, and lactate levels were followed for 5 hours. Data were analyzed by analysis of variance/Duncan multiple range test.

RESULTS

There were no significant differences in mortality between any groups. Groups I, IV, and V had lower (p < 0.05) cardiac output, pulmonary artery wedge pressure, and MAP than either group II or group III. Svo2 was significantly lower in the HBOC groups. There were no significant differences in arterial pH or lactate between groups I, III, and IV. Lactate levels, base excess, and arterial pH were significantly worse in the LR-alone and HBOC-50 groups.

CONCLUSION

Hypotensive resuscitation with HBOC-201 at a MAP of 60 mm Hg after a controlled hemorrhage in swine provides sufficient tissue perfusion and oxygen delivery to reverse anaerobic metabolism on the basis of global physiologic markers despite continued hypotension, hypovolemia, and low cardiac output.

Authors+Show Affiliations

United States Air Force Medical Corps, Department of General Surgery/MMKG, Wilford Hall Medical Center/59th Medical Wing, Lackland AFB, TX 78236-5300, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

11426122

Citation

McNeil, C J., et al. "Hypotensive Resuscitation Using a Polymerized Bovine Hemoglobin-based Oxygen-carrying Solution (HBOC-201) Leads to Reversal of Anaerobic Metabolism." The Journal of Trauma, vol. 50, no. 6, 2001, pp. 1063-75.
McNeil CJ, Smith LD, Jenkins LD, et al. Hypotensive resuscitation using a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) leads to reversal of anaerobic metabolism. J Trauma. 2001;50(6):1063-75.
McNeil, C. J., Smith, L. D., Jenkins, L. D., York, M. G., & Josephs, M. J. (2001). Hypotensive resuscitation using a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) leads to reversal of anaerobic metabolism. The Journal of Trauma, 50(6), 1063-75.
McNeil CJ, et al. Hypotensive Resuscitation Using a Polymerized Bovine Hemoglobin-based Oxygen-carrying Solution (HBOC-201) Leads to Reversal of Anaerobic Metabolism. J Trauma. 2001;50(6):1063-75. PubMed PMID: 11426122.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypotensive resuscitation using a polymerized bovine hemoglobin-based oxygen-carrying solution (HBOC-201) leads to reversal of anaerobic metabolism. AU - McNeil,C J, AU - Smith,L D, AU - Jenkins,L D, AU - York,M G, AU - Josephs,M J, PY - 2001/6/27/pubmed PY - 2001/8/3/medline PY - 2001/6/27/entrez SP - 1063 EP - 75 JF - The Journal of trauma JO - J Trauma VL - 50 IS - 6 N2 - BACKGROUND: Traditional resuscitation regimens have been recently challenged. This study evaluates hypotensive resuscitation with a hemoglobin-based oxygen-carrying (HBOC) solution after severe hemorrhage in a porcine model. We hypothesized that HBOC-201 restores tissue perfusion at a lower mean arterial pressure than standard resuscitation fluids. METHODS: Yorkshire swine (55-65 kg, n = 30), were rapidly hemorrhaged to a mean arterial pressure (MAP) of 30 mm Hg, maintained hypotensive for 45 minutes, and randomized into groups. Group I was resuscitated with an HBOC solution to a MAP of 60 mm Hg. Groups II and III were resuscitated to a MAP of 80 mm Hg with lactated Ringer's solution (LR) alone or LR (40 mL/kg) followed by shed blood, respectively. Group IV was resuscitated with shed blood alone to a MAP of 60 mm Hg. Group V received an HBOC solution to a MAP of 50 mm Hg. Hemodynamic variables, Swan-Ganz parameters, blood gas samples, and lactate levels were followed for 5 hours. Data were analyzed by analysis of variance/Duncan multiple range test. RESULTS: There were no significant differences in mortality between any groups. Groups I, IV, and V had lower (p < 0.05) cardiac output, pulmonary artery wedge pressure, and MAP than either group II or group III. Svo2 was significantly lower in the HBOC groups. There were no significant differences in arterial pH or lactate between groups I, III, and IV. Lactate levels, base excess, and arterial pH were significantly worse in the LR-alone and HBOC-50 groups. CONCLUSION: Hypotensive resuscitation with HBOC-201 at a MAP of 60 mm Hg after a controlled hemorrhage in swine provides sufficient tissue perfusion and oxygen delivery to reverse anaerobic metabolism on the basis of global physiologic markers despite continued hypotension, hypovolemia, and low cardiac output. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/11426122/Hypotensive_resuscitation_using_a_polymerized_bovine_hemoglobin_based_oxygen_carrying_solution__HBOC_201__leads_to_reversal_of_anaerobic_metabolism_ L2 - https://doi.org/10.1097/00005373-200106000-00015 DB - PRIME DP - Unbound Medicine ER -