Abstract 14744: Resuscitation by Prehospital Transfusion With Hemoglobin Vesicles in Trauma Induced Hemorrhagic Shock / Coagulopathy Rabbits
Introduction: Several investigators reported that polymerization of hemoglobin creates larger Hemoglobin-based oxygen carriers, may increase the likelihood of coagulopathy.
Hypothesis: We have developed Hemoglobin vesicle (HbV) as an artificial substitute for Red blood cells (RBC). The aim of this study was to evaluate the efficacy of HbV treatment during prehospital period in traumatic hemorrhagic shock / coagulopathy rabbits.
Methods: Hemorrhagic shock / thrombocytopenia were induced in rabbits by repeated blood withdrawal (total 400ml) and isovolemic transfusion of autologous washed RBC. Liver penetrating injury led lethal oozing hemorrhage. Prehospital phase: Uncontrolled hemorrhage was compensated by isovolemic transfusion of allogenic RBC transfusion (n=8), HbV (n=8) or Platelet poor plasma (PPP) (n=5) for initial 30 minutes. In-hospital phase: Then, platelet rich plasma (PRP) administration stopped bleeding. Subsequently, final RBC transfusion (n=16) or PPP (n=5) was administered as much as same volume of blood loss until hemostasis achieved period. Acute prognosis was compared among them for 24 hr. Hemodynamic and hematologic parameters were periodically recorded until the end of surgical procedure.
Results: In thrombocytopenic rabbits (platelets < 50,000 /μL, mean arterial pressure (MAP) < 50 mmHg), liver penetrating injury caused uncontrolled bleeding, then PRP administration restored platelets ≧ 70,000 /μL, which stopped bleeding within 40 min. At this point, dilutional anemia occurred as severe as class IV shock (Hb 6.0 g/dl, MAP approximately 50 mmHg). Prehospital administration of HbV as well as RBC transfusion regained MAP more than 55 mmHg, and they rescued more than 80 % animals, although rabbits receiving PPP showed 0% survival in the first 24 hours. HbV administration did not affect the coagulation parameters as well as RBC transfusion.
Conclusions: HbV may be effectively initial resuscitation fluid s for acute hemorrhagic shock with trauma induced coagulopathy.
Author Disclosures: K. Hagisawa: None. M. Kinoshita: None.
- © 2016 by American Heart Association, Inc.