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Prolonged low-volume resuscitation with HBOC-201 in a large-animal survival model of controlled hemorrhage.
J Trauma. 2005 Aug; 59(2):273-81; discussion 281-3.JT

Abstract

BACKGROUND

Military guidelines call for two 500-mL boluses of Hextend for resuscitation in far-forward environments. This study compared a hemoglobin-based oxygen carrier (HBOC-201; Hemopure) to Hextend when used to treat hemorrhagic shock in situations of delayed definitive care military operations.

METHODS

Yorkshire swine (55-65 kg) were hemorrhaged to a mean arterial blood pressure (MAP) of 30 mmHg. Hypotension was maintained for 45 minutes followed by resuscitation with either Hextend (HEX) (n = 8) or HBOC-201 (HBOC) (n = 8). Over 8 hours, animals received up to 1,000 mL of either fluid in an effort to sustain an MAP of 60 mmHg. At the end of 8 hours, HEX animals received 2 L of lactated Ringer's solution followed by shed blood. HBOC animals received 4 L of lactated Ringer's solution only. Animals were killed and necropsied on postprocedure day 5. Hemodynamic data were collected during shock and resuscitation. Complete blood counts, amylase, lactate, coagulation studies, and renal and liver function were measured throughout the experiment.

RESULTS

Equivalent volumes were hemorrhaged from each group (HBOC, 44.3 +/- 2.2 mL/kg; HEX, 47.4 +/- 3.0 mL/kg). The HBOC group achieved the goal MAP (HBOC, 60.0 +/- 2.3 mmHg; HEX, 46.4 +/- 2.3 mmHg; p < 0.01) and required less volume during the initial 8 hours (HBOC, 12.4 +/- 1.4 mL/kg; HEX, 17.3 +/- 0.3 mL/kg; p < 0.01). The HBOC group had lower SvO2 (HBOC, 46.3 +/- 2.4%; HEX, 50.7 +/- 2.5%; p = 0.12) and cardiac output (HBOC, 5.8 +/- 0.4 L/min; HEX, 7.2 +/- 0.6 L/min; p = 0.05), but higher systemic vascular resistance (HBOC, 821.4 +/- 110.7 dynes . s . cm-5; HEX, 489.6 +/- 40.6 dynes . s . cm-5; p = 0.01). Base excess, pH, lactate, and urine output did not differ between groups. HEX group survival was 50% (four of eight) versus 88% for the HBOC group (seven of eight). All animals survived the initial 8 hours. Animals surviving 5 days displayed no clinical or laboratory evidence of organ dysfunction in either group.

CONCLUSION

HBOC-201 more effectively restored and maintained perfusion pressures with lower volumes, and allowed for improved survival. These data suggest that hemoglobin-based oxygen carriers are superior to the current standard of care for resuscitation in far-forward military operations.

Authors+Show Affiliations

Department of Surgery, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16294065

Citation

Fitzpatrick, Colleen M., et al. "Prolonged Low-volume Resuscitation With HBOC-201 in a Large-animal Survival Model of Controlled Hemorrhage." The Journal of Trauma, vol. 59, no. 2, 2005, pp. 273-81; discussion 281-3.
Fitzpatrick CM, Biggs KL, Atkins BZ, et al. Prolonged low-volume resuscitation with HBOC-201 in a large-animal survival model of controlled hemorrhage. J Trauma. 2005;59(2):273-81; discussion 281-3.
Fitzpatrick, C. M., Biggs, K. L., Atkins, B. Z., Quance-Fitch, F. J., Dixon, P. S., Savage, S. A., Jenkins, D. H., & Kerby, J. D. (2005). Prolonged low-volume resuscitation with HBOC-201 in a large-animal survival model of controlled hemorrhage. The Journal of Trauma, 59(2), 273-81; discussion 281-3.
Fitzpatrick CM, et al. Prolonged Low-volume Resuscitation With HBOC-201 in a Large-animal Survival Model of Controlled Hemorrhage. J Trauma. 2005;59(2):273-81; discussion 281-3. PubMed PMID: 16294065.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prolonged low-volume resuscitation with HBOC-201 in a large-animal survival model of controlled hemorrhage. AU - Fitzpatrick,Colleen M, AU - Biggs,Kristen L, AU - Atkins,B Zane, AU - Quance-Fitch,Fonzie J, AU - Dixon,Patricia S, AU - Savage,Stephanie A, AU - Jenkins,Donald H, AU - Kerby,Jeffrey D, PY - 2005/11/19/pubmed PY - 2005/12/21/medline PY - 2005/11/19/entrez SP - 273-81; discussion 281-3 JF - The Journal of trauma JO - J Trauma VL - 59 IS - 2 N2 - BACKGROUND: Military guidelines call for two 500-mL boluses of Hextend for resuscitation in far-forward environments. This study compared a hemoglobin-based oxygen carrier (HBOC-201; Hemopure) to Hextend when used to treat hemorrhagic shock in situations of delayed definitive care military operations. METHODS: Yorkshire swine (55-65 kg) were hemorrhaged to a mean arterial blood pressure (MAP) of 30 mmHg. Hypotension was maintained for 45 minutes followed by resuscitation with either Hextend (HEX) (n = 8) or HBOC-201 (HBOC) (n = 8). Over 8 hours, animals received up to 1,000 mL of either fluid in an effort to sustain an MAP of 60 mmHg. At the end of 8 hours, HEX animals received 2 L of lactated Ringer's solution followed by shed blood. HBOC animals received 4 L of lactated Ringer's solution only. Animals were killed and necropsied on postprocedure day 5. Hemodynamic data were collected during shock and resuscitation. Complete blood counts, amylase, lactate, coagulation studies, and renal and liver function were measured throughout the experiment. RESULTS: Equivalent volumes were hemorrhaged from each group (HBOC, 44.3 +/- 2.2 mL/kg; HEX, 47.4 +/- 3.0 mL/kg). The HBOC group achieved the goal MAP (HBOC, 60.0 +/- 2.3 mmHg; HEX, 46.4 +/- 2.3 mmHg; p < 0.01) and required less volume during the initial 8 hours (HBOC, 12.4 +/- 1.4 mL/kg; HEX, 17.3 +/- 0.3 mL/kg; p < 0.01). The HBOC group had lower SvO2 (HBOC, 46.3 +/- 2.4%; HEX, 50.7 +/- 2.5%; p = 0.12) and cardiac output (HBOC, 5.8 +/- 0.4 L/min; HEX, 7.2 +/- 0.6 L/min; p = 0.05), but higher systemic vascular resistance (HBOC, 821.4 +/- 110.7 dynes . s . cm-5; HEX, 489.6 +/- 40.6 dynes . s . cm-5; p = 0.01). Base excess, pH, lactate, and urine output did not differ between groups. HEX group survival was 50% (four of eight) versus 88% for the HBOC group (seven of eight). All animals survived the initial 8 hours. Animals surviving 5 days displayed no clinical or laboratory evidence of organ dysfunction in either group. CONCLUSION: HBOC-201 more effectively restored and maintained perfusion pressures with lower volumes, and allowed for improved survival. These data suggest that hemoglobin-based oxygen carriers are superior to the current standard of care for resuscitation in far-forward military operations. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/16294065/Prolonged_low_volume_resuscitation_with_HBOC_201_in_a_large_animal_survival_model_of_controlled_hemorrhage_ L2 - https://doi.org/10.1097/01.ta.0000174730.62338.88 DB - PRIME DP - Unbound Medicine ER -