Can Polyethylene Glycol-20k Replace Albumin for Prehospital Treatment of Hemorrhagic Shock When Full Resuscitation Is Unavailable?

Abstract

A solution of high concentration albumin has been used for temporal volume expansion when timely resuscitation was unavailable after hemorrhagic shock. However, during prolonged hemorrhagic shock, cell edema and interstitial dehydration can occur and impede the volume expansion effect of albumin. Polyethylene glycol-20K (PEG) can establish an osmotic gradient from swollen cells to capillary lumens and thus facilitate capillary fluid shift and volume expansion. We hypothesized that with similar osmolality, 7.5% PEG elicits more rapid and profound compensatory responses after hemorrhagic shock than 25% albumin. Rats were randomized into three groups (n = 8/group) based on treatment: saline (vehicle), PEG (7.5%), and albumin (25%). Trauma was induced in anesthetized rats with muscle injury and fibula fracture, followed by pressure-controlled hemorrhagic shock (MAP = 55 mm Hg) for 45 min. Animals then received an intravenous injection (0.3 mL/kg) of saline, PEG, or albumin. MAP, heart rate, blood gases, hematocrit, skeletal muscle capillary flow, renal blood flow, glomerular filtration rate, urinary flow, urinary sodium concentration, and mortality were monitored for another 2 hours. Polyethylene glycol-20K and albumin both improved MAP, renal and capillary blood flow, and renal oxygen delivery, and decreased hyperkalemia, hyperlactatemia, hematocrit, and mortality (saline: 100% PEG: 12.5%; albumin: 38%) over saline treatment. Compared with albumin, PEG had a more rapid decrease in hematocrit and more profound increases in MAP, diastolic pressure, renal blood flow, glomerular filtration rate, and urinary flow. These results suggest that PEG may be a better option than albumin for prolonged prehospital care of hemorrhagic shock.

25% Human Serum Albumin Improves Hemodynamics and Prevents the Need for Nearly All Pre-Hospital Resuscitation in a Rat (Rattus Norvegicus) Model of Trauma and Hemorrhage

“…A recent study by another group compared resuscitation after hemorrhage with a 7.5% 20 kDa-polyethylene glycol to saline or to a nonpharmaceutical (i.e., no- or low-NEFA) 25% albumin at a dose nearly identical to ours. While their albumin was significantly better than saline, it was not as beneficial as the artificial colloid (30), suggesting to us that the artificial colloid may have had an additional constricting effect similar to what NEFA gives pharmaceutical albumin. Moving forward, we are focused on finding ways to recreate the benefits of NEFA + albumin, without the NEFA, including an ongoing study examining the effects of infusion of moderate amounts of cfHb for the purpose of improving compensation (as opposed to using it to increase oxygen carrying capacity).…”

Shear Stress and Endothelial Mechanotransduction in Trauma Patients with Hemorrhagic Shock: Hidden Coagulopathy Pathways and Novel Therapeutic Strategies

“…Administration of crystalloids aggravates glycocalyx damage, increases plasma syndecan-1 levels, and worsens permeability [53], while albumin may only partially restore endothelial glycocalyx thickness [54]. Polyethylene glycol-20K (PEG) can establish an osmotic gradient from swollen cells to capillary lumens, facilitating capillary fluid shift and volume expansion, and thus it may be a better option than albumin for prolonged care of hemorrhagic shock [55]. Also, fresh frozen plasma may completely restore endothelial glycocalyx thickness, but may not be helpful in increasing shed syndecan-1 levels [54,56,57].…”

Editorial: Shock and resuscitation

“…Hypotensive resuscitation with antishock compounds for volume expansion was studied for golden hour extension in the case where full resuscitation is unavailable during prehospital care (Parrish et al, 2016;Xiang et al, 2023). A low dose of Centhaquine was shown to cause venous constriction thereby elevating venous return and cardiac output (Geevarghese et al), and subsequently increasing blood pressure compensation in response to hemorrhage.…”