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Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine.
J Trauma. 2006 Jul; 61(1):46-56.JT

Abstract

BACKGROUND

Data are limited on the actions of hemoglobin based oxygen carriers (HBOCs) after traumatic brain injury (TBI). This study evaluates neurotoxicity, vasoactivity, cardiac toxicity, and inflammatory activity of HBOC-201 (Biopure, Cambridge, Mass.) resuscitation in a TBI model.

METHODS

Swine received TBI and hemorrhage. After 30 minutes, resuscitation was initiated with 10 mL/kg normal saline (NS), followed by either HBOC-201 (6 mL/kg, n = 10) or NS control (n = 10). Supplemental NS was administered to both groups to maintain mean arterial pressure (MAP) >60 mm Hg until 60 minutes, and to maintain cerebral perfusion pressure (CPP) >70 mm Hg from 60 to 300 minutes. The control group received mannitol (1 g/kg) and blood (10 mL/kg) at 90 minutes and half (n = 5) received CPP directed phenylephrine (PE) therapy after 120 minutes. Serum cytokines were measured with ELISA and coagulation was evaluated with thromboelastography. Brains were harvested for neuropathology.

RESULTS

With HBOC administration, MAP, CPP, and brain tissue PO2 were restored within 30 minutes and maintained until 300 minutes. Clot strength and fibrin formation were maintained and 9/10 successfully extubated. In contrast, with control, MAP and brain tissue PO2 did not correct until 120 minutes, after mannitol, transfusion and 40% more crystalloid. Furthermore, without PE, CPP did not reach target and 0/5 could be extubated. Lactate, heart rate, cardiac output, mixed venous oxygenation, muscle oxygenation, serum cytokines, and histology did not differ between groups.

CONCLUSIONS

After TBI, a single HBOC-201 bolus with minimal supplements provided rapid resuscitation, while maintaining CPP and improving brain oxygenation, without causing cardiac dysfunction, coagulopathy, cytokine release, or brain structural changes.

Authors+Show Affiliations

Division of Trauma, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16832248

Citation

Patel, Mayur B., et al. "Prehospital HBOC-201 After Traumatic Brain Injury and Hemorrhagic Shock in Swine." The Journal of Trauma, vol. 61, no. 1, 2006, pp. 46-56.
Patel MB, Feinstein AJ, Saenz AD, et al. Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine. J Trauma. 2006;61(1):46-56.
Patel, M. B., Feinstein, A. J., Saenz, A. D., Majetschak, M., & Proctor, K. G. (2006). Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine. The Journal of Trauma, 61(1), 46-56.
Patel MB, et al. Prehospital HBOC-201 After Traumatic Brain Injury and Hemorrhagic Shock in Swine. J Trauma. 2006;61(1):46-56. PubMed PMID: 16832248.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine. AU - Patel,Mayur B, AU - Feinstein,Ara J, AU - Saenz,Alvaro D, AU - Majetschak,Matthias, AU - Proctor,Kenneth G, PY - 2006/7/13/pubmed PY - 2006/8/19/medline PY - 2006/7/13/entrez SP - 46 EP - 56 JF - The Journal of trauma JO - J Trauma VL - 61 IS - 1 N2 - BACKGROUND: Data are limited on the actions of hemoglobin based oxygen carriers (HBOCs) after traumatic brain injury (TBI). This study evaluates neurotoxicity, vasoactivity, cardiac toxicity, and inflammatory activity of HBOC-201 (Biopure, Cambridge, Mass.) resuscitation in a TBI model. METHODS: Swine received TBI and hemorrhage. After 30 minutes, resuscitation was initiated with 10 mL/kg normal saline (NS), followed by either HBOC-201 (6 mL/kg, n = 10) or NS control (n = 10). Supplemental NS was administered to both groups to maintain mean arterial pressure (MAP) >60 mm Hg until 60 minutes, and to maintain cerebral perfusion pressure (CPP) >70 mm Hg from 60 to 300 minutes. The control group received mannitol (1 g/kg) and blood (10 mL/kg) at 90 minutes and half (n = 5) received CPP directed phenylephrine (PE) therapy after 120 minutes. Serum cytokines were measured with ELISA and coagulation was evaluated with thromboelastography. Brains were harvested for neuropathology. RESULTS: With HBOC administration, MAP, CPP, and brain tissue PO2 were restored within 30 minutes and maintained until 300 minutes. Clot strength and fibrin formation were maintained and 9/10 successfully extubated. In contrast, with control, MAP and brain tissue PO2 did not correct until 120 minutes, after mannitol, transfusion and 40% more crystalloid. Furthermore, without PE, CPP did not reach target and 0/5 could be extubated. Lactate, heart rate, cardiac output, mixed venous oxygenation, muscle oxygenation, serum cytokines, and histology did not differ between groups. CONCLUSIONS: After TBI, a single HBOC-201 bolus with minimal supplements provided rapid resuscitation, while maintaining CPP and improving brain oxygenation, without causing cardiac dysfunction, coagulopathy, cytokine release, or brain structural changes. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/16832248/Prehospital_HBOC_201_after_traumatic_brain_injury_and_hemorrhagic_shock_in_swine_ L2 - https://doi.org/10.1097/01.ta.0000219730.71206.3a DB - PRIME DP - Unbound Medicine ER -