Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury

Stern, Susan A.; Dronen, Steven C.; Birrer, Patrick; Wang, Xu

doi:10.1016/s0196-0644(05)80195-7

Cited by 335 publications

(156 citation statements)

References 23 publications

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“…7 The MAP was raised to 40, 60, and 80 mmHg by normal saline infused at 6 ml/kg/min, which was later changed to blood transfusions. The mortality was 11%, 22%, and 78%, respectively.…”

Section: Effect Of Arterial Pressurementioning

confidence: 99%

“…Based on the previous work, one would expect 25% mortality to result from the infused volume, but instead, the figure found corresponded to that obtained by using the same infusion rate. 2 It also became even more evident that the earliest studies using the aortic tear model 6,7,9 had infused crystalloid fluid much too fast to promote survival.…”

Section: Varying the Infused Volumementioning

confidence: 99%

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Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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Intravenous fluid is life-saving in hypovolemic shock, but fluid sometimes aggravates the bleeding. During the past 25 years, animal models have helped our understanding of the mechanisms involved in this unexpected effect. A key issue is that vasoconstriction is insufficient to arrest the bleeding when damage is made to a major blood vessel. ‘Uncontrolled hemorrhage’ is rather stopped by a blood clot formed at the outside surface of the vessel, and the immature clot is sensitive to mechanical and chemical interactions. The mortality increases if rebleeding occurs. In the aortic tear model in swine, hemorrhage volume and the mortality increase from effective restoration of the arterial pressure. The mortality vs. amount of fluid curve is U-shaped with higher mortality at either end. Without any fluid at all, irreversible shock causes death provided the hemorrhage is sufficiently large. Crystalloid fluid administered in a 3 : 1 proportion to the amount of lost blood initiates serious rebleeding. Hypertonic saline 7.5% in 6% dextran 70 (HSD) also provokes rebleeding resulting in higher mortality in the recommended dosage of 4 ml/kg. Uncontrolled hemorrhage models in rats, except for the ‘cut-tail’ model, confirm the results from swine. To avoid rebleeding, fluid programs should not aim to fully restore the arterial pressure, blood flow rates, or blood volume. For a hemorrhage of 1000 ml, computer simulations show that deliberate hypovolemia (−300 ml) would be achieved by infusing 600–750 ml crystalloid fluid over 20–30 min or 100 ml of HSD over 10–20 min in an adult male

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“…7 The MAP was raised to 40, 60, and 80 mmHg by normal saline infused at 6 ml/kg/min, which was later changed to blood transfusions. The mortality was 11%, 22%, and 78%, respectively.…”

Section: Effect Of Arterial Pressurementioning

confidence: 99%

Section: Varying the Infused Volumementioning

confidence: 99%

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Hahn

2012

Acta Anaesthesiol Scand

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“…This theory is supported by a previously published study in which animals were resuscitated in the presence of an aortic tear to an MAP of either 40, 60, or 80 mm Hg. 18 In that study, animals most aggressively resuscitated (to an MAP of 80 mm Hg) experienced significantly greater hemorrhage volumes and short-term mortality. Of note is the fact that the greater hemorrhage volume was associated with a very early rapid rise in pulse pressure.…”

Section: Discussionmentioning

confidence: 84%

“…This is consistent with the previously described literature, which suggests that slow progressive or delayed increases in BP may avoid the detrimental effects of equivalent but rapid early changes in BP that occur with early aggressive resuscitation. 18,25 In summary, the differences in outcome between studies of hypertonic saline resuscitation of acute hemorrhage are likely the result of substantive differences in study designs. These conflicting data reiterate a principle that the hemorrhagic shock literature has previously demonstrated; that is, the effect of a given resuscitation strategy varies depending on the setting, and one must carefully consider the clinical setting that a given laboratory model represents when interpreting the data.…”

Section: Discussionmentioning

confidence: 99%

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Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Stern¹,

Jwayyed²,

Dronen³

et al. 2000

Academic Emergency Medicine

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Abstract.Objectives: Resuscitation studies of hypertonic saline using controlled and uncontrolled hemorrhage models yield conflicting results with regard to efficacy. These disparate results reflect the use of models and resuscitation regimens that are not comparable between studies. This study evaluated the effects of comparable and clinically relevant resuscitation regimens of 7.5% sodium chloride/6% dextran 70 (HSD) and 0.9% sodium chloride (NS) in a near-fatal uncontrolled hemorrhage model. Methods: Thirty-six swine (14.2 to 21.4 kg) with 4-mm aortic tears were bled to a pulse pressure of 5 mm Hg (40-45 mL/kg). The animals were resuscitated with either NS or HSD administered in volumes that provided equivalent sodium loads at similar rates. Group II (n = 12) was resuscitated with 80 mL/kg of NS at a rate of 4 mL/kg/min. Group III (n = 12) received 9.6 mL/ kg of HSD at a rate of 0.48 mL/kg/min. In both groups, crystalloid resuscitation was followed by shed blood infusion (30 mL/kg) at a rate of 2 mL/kg/min. Group I (controls; n = 12) were not resuscitated. Results: One-hour mortality was significantly greater in group I (92%) as compared with group II (33%) and group III (33%) (Fisher's exact test; p = 0.004). Intraperitoneal hemorrhage was significantly greater in group II (34 Ϯ 20 mL/kg) and group III (31 Ϯ 13 mL/ kg) as compared with group I (5 Ϯ 2 mL/kg) (ANOVA; p < 0.05). There was no significant difference in hemodynamic parameters between groups II and III. Conclusion: In this model of severe uncontrolled hemorrhage, resuscitation with HSD or NS, administered in volumes that provided equivalent sodium loads at similar rates, had similar effects on mortality, hemodynamic parameters, and hemorrhage from the injury site. Key words: uncontrolled hemorrhage; shock; resuscitation; hypertonic saline; hemorrhage models; pig. ACADEMIC EMERGENCY MEDICINE 2000; 7:847-856 S TANDARD management of acute life-threatening hemorrhagic hypotension includes attempts to restore blood pressure (BP) to normal or near-normal levels through rapid administration of large volumes of isotonic crystalloid. 1 An alternative resuscitation agent that has shown considerable promise is 7.5% sodium chloride (HTS), used alone or in combination with 6% dextran 70 (HSD). Several animal studies of acute hemorrhagic hypotension have demonstrated that smallvolume infusions of HTS and HSD are more effec- tive in increasing BP, increasing cardiac output, and providing volume expansion as compared with conventional isotonic crystalloids. 2-10 Based on these studies, several authors have advocated the out-of-hospital administration of hypertonic crystalloids for acute hemorrhagic shock. However, not all of the hypertonic saline studies have demonstrated improvement in outcome from resuscitation of acute hemorrhage. More recent studies demonstrate that hypertonic saline resuscitation increases hemorrhage volume and mortality, presumably the result of a rapid rise in BP. [11][12][13][14][15] The authors of the latter studies therefore caution ...

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Diaspirin Cross-Linked Hemoglobin (DCLHb) in the Treatment of Severe Traumatic Hemorrhagic Shock<SUBTITLE>A Randomized Controlled Efficacy Trial</SUBTITLE>

Sloan¹

1999

JAMA

442

235

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Effect of blood pressure on hemorrhage volume and survival in a near-fatal hemorrhage model incorporating a vascular injury

Cited by 335 publications

References 23 publications

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us

Resuscitation of Severe Uncontrolled Hemorrhage 7.5% Sodium Chloride/6% Dextran 70 vs 0.9% Sodium Chloride

Diaspirin Cross-Linked Hemoglobin (DCLHb) in the Treatment of Severe Traumatic Hemorrhagic Shock<SUBTITLE>A Randomized Controlled Efficacy Trial</SUBTITLE>

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