Abstract 20: Description of Dilutional Coagulopathy During Crystalloid Fluid Resuscitation in Hemorrhagic Shock
Background: Coagulopathy is a deadly complication of hemorrhagic shock (HS). Current management of HS includes the administration of IV crystalloid, which may contribute to the development of a dilutional coagulopathy. This study characterizes the effect of crystalloid resuscitation on coagulation parameters in a model of uncontrolled HS.
Methods: Immature female swine (26-35 kg, n=55) underwent 5 mm arteriotomy of the femoral artery, were allowed to bleed freely for either 30 or 45 seconds, followed by hemorrhage control with one of 7 mechanical interventions. Following attempted hemorrhage control, all animals received 15ml/kg of Hextend™, followed by either Lactated Ringers (LR) infused at 3ml/kg/min as needed for mean arterial pressure less than 60 mmHg or no further fluids. Animals were observed for 180 minutes. Regression models were used to evaluate the ability of infused crystalloid volume to predict thromboelastogram maximum amplitude (TEG MA), fibrinogen level (FBG), and platelet count (PLT) over the resuscitation period, controlling for hemostatic intervention type. These models were run with and without adjustment for cumulative hemorrhage volume.
Results: Higher volumes of infused crystalloid were predictive of lower TEG MA (p<0.001), lower FBG (p<0.001), and lower PLT (p<0.001). For each 10 ml/kg increase in crystalloid, there was an associated decrease in TEG MA of 1.3 mm (95% CI: 1.0 - 1.5), decrease in FBG of 9.5 mg/dL (95% CI: 8.1 - 10.8), and decrease in PLT of 15.6 x 109/L (95% CI: 12.0 - 19.2). After adjusting for hemorrhage volume, the effect on PLT was weaker (p=0.079), but the effects on TEG MA and FBG remained strong (p=0.034 and <0.001, respectively).
Conclusion: Higher volumes of infused crystalloid fluids were associated with lower TEG MA’s, FBG concentrations, and PLT counts. This effect remained strong for TEG MA and FBG after adjusting for hemorrhage volume. While it is difficult to know which model more accurately reflects the direct effects of crystalloid fluids, the data demonstrate that crystalloid infusion is associated with worse coagulopathy and that TEG MA and FBG concentration are especially sensitive to this. This lends further support to limiting crystalloid fluid resuscitation in patients with active hemorrhage.
Author Disclosures: A. St. John: Other Research Support; Significant; Study supported by funds from iTrauma Care. X. Wang: Other Research Support; Significant; Study supported by funds from iTrauma Care. E. Lim: Other Research Support; Significant; Study supported by funds from iTrauma Care. S. Stern: Other Research Support; Significant; Study supported by funds from iTrauma Care. N. White: Other Research Support; Significant; Study supported by funds from iTrauma Care.
- © 2014 by American Heart Association, Inc.