Comparison of shelf-stable and conventional resuscitation products in a canine model of hemorrhagic shock.
| Autor: | Edwards TH; From the US Army Institute of Surgical Research (T.H.E., E.C.V., T.D.L., L.E.G.II), JBSA Fort Sam Houston; Department of Veterinary Small Animal Clinical Sciences (T.H.E.), School of Veterinary Medicine, Texas A&M University, College Station; Department of Epidemiology and Biostatistics (T.D.L.), University of Texas Tyler School of Medicine, Tyler, Texas; Oak Ridge Institute for Science and Education (L.E.G.II), Oak Ridge, Tennessee; Nora Eccles-Harrison Cardiovascular Research and Training Institute (T.H., G.L.H.); Biomedical Engineering Department (G.L.H.), and Department of Emergency Medicine (R.F., N.E., R.G., C.C., A.T., G.L.H.), University of Utah Health, Salt Lake City, Utah., Venn EC, Le TD, Grantham LE 2nd, Hogen T, Ford R, Ewer N, Gunville R, Carroll C, Taylor A, Hoareau GL |
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| Jazyk: | angličtina |
| Zdroj: | The journal of trauma and acute care surgery [J Trauma Acute Care Surg] 2024 Aug 01; Vol. 97 (2S Suppl 1), pp. S105-S112. Date of Electronic Publication: 2024 May 06. |
| DOI: | 10.1097/TA.0000000000004332 |
| Abstrakt: | Background: Treatment of severe hemorrhagic shock typically involves hemostatic resuscitation with blood products. However, logistical constraints often hamper the wide distribution of commonly used blood products like whole blood. Shelf-stable blood products and blood substitutes are poised to be able to effectively resuscitate individuals in hemorrhagic shock when more conventional blood products are not readily available. Methods: Purpose-bred adult dogs (n = 6) were anesthetized, instrumented, and subjected to hemorrhagic shock (mean arterial pressure <50 mm Hg or 40% blood volume loss). Then each dog was resuscitated with one of five resuscitation products: (1) lactated ringers solution and hetastarch (LRS/Heta), (2) canine chilled whole blood (CWB), (3) fresh frozen plasma (FFP) and packed red blood cells (pRBC), (4) canine freeze-dried plasma (FDP) and hemoglobin-based oxygen carrier (HBOC), or (5) HBOC/FDP and canine lyophilized platelets (LyoPLT). Each dog was allowed to recover after the hemorrhage resuscitation event and was then subjected to another hemorrhage event and resuscitated with a different product until each dog was resuscitated with each product. Results: At the time when animals were determined to be out of shock as defined by a shock index <1, mean arterial pressure (mmHg) values (mean ± standard error) were higher for FFP/pRBC (n = 5, 83.7 ± 4.5) and FDP/HBOC+LyoPLT (n = 4, 87.8 ± 2.1) as compared with WB (n = 4, 66.0 ± 13.1). A transient increase in creatinine was seen in dogs resuscitated with HBOC and FDP. Albumin and base excess increased in dogs resuscitated with HBOC and FDP products compared with LRS/heta and CWB ( p < 0.01). Conclusion: Combinations of shelf-stable blood products compared favorably to canine CWB for resolution of shock. Further research is needed to ascertain the reliability and efficacy of these shelf-stable combinations of products in other models of hemorrhage that include a component of tissue damage as well as naturally occurring trauma. (Copyright © 2024 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.) |
| Databáze: | MEDLINE |
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