Effects of a combination hemoglobin based oxygen carrier-hypertonic saline solution on oxygen transport in the treatment of traumatic shock

Abstract

Background: Logistics complicate fluid resuscitation of traumatic shock on the battlefield. Traumatic shock can result in oxygen debt (O 2D) accumulation that is fatal. However, the ability of fluid strategies to repay O 2D are not commonly reported. This pilot study examined various resuscitation fluids, including a combination of PEGylated bovine hemoglobin and hypertonic saline (AfterShock™) on their ability to repay O 2D in traumatic shock. Methods: 41 anesthetized swine underwent hemorrhage to an O 2D of 80mL/kg. Animals received one of the following: 500mL whole blood, 500mL AfterShock™, 500mL hypertonic (7.2%) saline, 250mL hypertonic (7.2%) saline, 500mL Hetastarch (6%), or 500mL lactated Ringer's. Oxygen transport variables (O 2D, oxygen consumption, oxygen delivery, central venous hemoglobin oxygen saturation, oxygen extraction ratios), lactate clearance, and survival were monitored for 3h after treatment. Data were analyzed using mixed-model ANOVA and comparisons were made to the performance of whole blood. Results: Only animals receiving AfterShock™, 500mL hypertonic saline, and 500mL Hetastarch survived to 180min. While not statistically significant AfterShock™ demonstrated trends in improving the repayment of O 2D and in improving oxygen transport variables despite having lower levels of global oxygen delivery compared to whole blood, Hetastarch and 500mL hypertonic saline groups. Conclusion: Use of 500mL AfterShock™, 500mL of 7.2% saline or 500mL of Hetastarch resulted in improved short-term survival. While not statistically significant, AfterShock™ demonstrated trends in improving O 2D. These findings may have implications for designing resuscitation fluids for combat casualty care. © 2011 Elsevier Ireland Ltd.