Abstract 7: Vasopressin and Restrictive Fluid Resuscitation Improves Survival from Hemorrhagic Shock After Liver Laceration in Swine
Background: Previous studies in swine models of hemorrhagic shock (HS) designed by us to assess interventions that could be applied in the battlefield showed that vasopressin (VP) infusion promotes hemodynamic stability and markedly improves survival. In these studies, however, blood was removed through a cannula lacking the tissue injury and uncontrolled nature of trauma-associated HS. We report here the effects of VP infusion and restrictive fluid resuscitation during HS in a model of liver laceration (LL) that incorporates the effects of uncontrolled bleeding and tissue injury.
Methods: Forty male domestic pigs (32.3 to 40.3 kg) had the left lateral liver lobe lacerated using a sharpened steel, X-shaped 5 cm blade clamp, resembling a gunshot wound. Thirty-two animals received a second LL in the same lobe 7.5 minutes later and 24 animals received a third LL in the left medial lobe at 15 minutes from the first LL. Animals were randomized 1:1:1:1 to receive VP, normal saline (NS), VP and NS, or neither VP nor NS. VP (0.04 U/kg•min-1) or vehicle was infused intraosseously starting 7 minutes after the first LL until the end of the experiment (240 min). NS (12 mL/kg) was given at 30 minutes from the initial LL.
Results: Kaplan-Meier survival curves (Figure) showed an overall difference in survival with a p-value of 0.095 favoring the combination of VP and NS (VP-NS; 8/10) followed by VP without NS (VP+noNS; 4/10), NS without VP (noVP+NS; 3/10), and no intervention (noVP+noNS; 3/10). The total blood loss was similar in all four groups. The survival time course suggests that VP infusion prevented early demise (i.e., vasopressor effect maintaining vital organ perfusion) and that NS subsequently promoted lasting hemodynamic stability (i.e., preload effect sustaining forward blood flow).
Conclusion: These findings support a potential survival effect of early and sustained VP infusion in combination with restricted fluid resuscitation for severe HS in the battlefield.
Author Disclosures: H.K. Whitehouse: None. A. Baetiong: None. J. Radhakrishnan: None. R.J. Gazmuri: Research Grant; Significant; Supported by the Telemedicine and Advanced Technology Research Center (TATRC) at the U.S. Army Medical Research and Materiel Command (USAMRMC) Fort Detrick, MD under contract number: W81XWH-11-2-0019.
- © 2014 by American Heart Association, Inc.