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Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model.
J Trauma. 2006 Jul; 61(1):57-64; discussion 64-5.JT

Abstract

BACKGROUND

Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability.

METHODS

There were 20 anesthetized swine (35 +/- 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0') and study end (120'). Thrombelastography was performed at 0'and postinjury at 30', 60', 90', and 120'.

RESULTS

There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p < 0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p < 0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009).

CONCLUSIONS

This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock.

Authors+Show Affiliations

Oregon Health & Science University, Portland, Oregon 97239, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

16832250

Citation

Kiraly, Laszlo N., et al. "Resuscitation With Normal Saline (NS) Vs. Lactated Ringers (LR) Modulates Hypercoagulability and Leads to Increased Blood Loss in an Uncontrolled Hemorrhagic Shock Swine Model." The Journal of Trauma, vol. 61, no. 1, 2006, pp. 57-64; discussion 64-5.
Kiraly LN, Differding JA, Enomoto TM, et al. Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. J Trauma. 2006;61(1):57-64; discussion 64-5.
Kiraly, L. N., Differding, J. A., Enomoto, T. M., Sawai, R. S., Muller, P. J., Diggs, B., Tieu, B. H., Englehart, M. S., Underwood, S., Wiesberg, T. T., & Schreiber, M. A. (2006). Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. The Journal of Trauma, 61(1), 57-64; discussion 64-5.
Kiraly LN, et al. Resuscitation With Normal Saline (NS) Vs. Lactated Ringers (LR) Modulates Hypercoagulability and Leads to Increased Blood Loss in an Uncontrolled Hemorrhagic Shock Swine Model. J Trauma. 2006;61(1):57-64; discussion 64-5. PubMed PMID: 16832250.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resuscitation with normal saline (NS) vs. lactated ringers (LR) modulates hypercoagulability and leads to increased blood loss in an uncontrolled hemorrhagic shock swine model. AU - Kiraly,Laszlo N, AU - Differding,Jerome A, AU - Enomoto,T Miko, AU - Sawai,Rebecca S, AU - Muller,Patrick J, AU - Diggs,Brian, AU - Tieu,Brandon H, AU - Englehart,Michael S, AU - Underwood,Samantha, AU - Wiesberg,Tracy T, AU - Schreiber,Martin A, PY - 2006/7/13/pubmed PY - 2006/8/19/medline PY - 2006/7/13/entrez SP - 57-64; discussion 64-5 JF - The Journal of trauma JO - J Trauma VL - 61 IS - 1 N2 - BACKGROUND: Lactated ringers (LR) and normal saline (NS) are used interchangeably in many trauma centers. The purpose of this study was to compare the effects of LR and NS on coagulation in an uncontrolled hemorrhagic swine model. We hypothesized resuscitation with LR would produce hypercoagulability. METHODS: There were 20 anesthetized swine (35 +/- 3 kg) that underwent central venous and arterial catheterization, celiotomy, and splenectomy. After splenectomy blinded study fluid equal to 3 mL per gram of splenic weight was administered. A grade V liver injury was made and animals bled without resuscitation for 30 minutes. Animals were resuscitated with the respective study fluid to, and maintained, at the preinjury MAP until study end. Prothrombin Time (PT), Partial Thromboplastin Time (PTT), and fibrinogen were collected at baseline (0') and study end (120'). Thrombelastography was performed at 0'and postinjury at 30', 60', 90', and 120'. RESULTS: There were no significant baseline group differences in R value, PT, PTT, and fibrinogen. There was no significant difference between baseline and 30 minutes R value with NS (p = 0.17). There was a significant R value reduction from baseline to 30 minutes with LR (p = 0.02). At 60 minutes, R value (p = 0.002) was shorter while alpha angle, maximum amplitude, and clotting index were higher (p < 0.05) in the LR versus the NS group. R value, PT, and PTT were significantly decreased at study end in the LR group compared with the NS group (p < 0.05). Overall blood loss was significantly higher in the NS versus LR group (p = 0.009). CONCLUSIONS: This data indicates that resuscitation with LR leads to greater hypercoagulability and less blood loss than resuscitation with NS in uncontrolled hemorrhagic shock. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/16832250/Resuscitation_with_normal_saline__NS__vs__lactated_ringers__LR__modulates_hypercoagulability_and_leads_to_increased_blood_loss_in_an_uncontrolled_hemorrhagic_shock_swine_model_ L2 - https://doi.org/10.1097/01.ta.0000220373.29743.69 DB - PRIME DP - Unbound Medicine ER -